Feb 17, 2014 ... providers to continue providing medical care to our patients and families. ... of our
differences with United, we provide this letter to help explain ...
Mark Strong, Managing Director Nemours Managed Care 10140 Centurion Parkway Jacksonville, FL 32256
February 17, 2014
Dear Physician: At Nemours, we value our relationships with community physicians and the trust you place in us to care for your patients. This letter is to inform you about an upcoming change with one of our managed care plans. Nemours Children’s Clinic will no longer be a participating provider for UnitedHealthcare Community Plan of Florida (United), a Florida Medicaid HMO and Florida Healthy Children HMO, effective April 1, 2014. This includes Nemours’ providers located at Nemours Children’s Clinic, Jacksonville; Nemours Children’s Clinic, Orlando or Nemours Children’s Clinic, Pensacola (Collectively “Nemours”). Recognizing the importance of this potential change to our patients and families, we continue to work in good faith with United for a contract that will allow Nemours’ providers to continue providing medical care to our patients and families. To date, United has not accepted Nemours’ proposal. While we continue to work toward a successful resolution of our differences with United, we provide this letter to help explain how this contract termination may impact your United patients’ ability to seek health care from a Nemours’ provider. What does this contract’s termination mean to you and your patients? If you are interested in continuing to refer a United patient to a Nemours’ provider, we suggest you call United’s Network Management Department at (813) 890-4551 to request an out-of-network (ONN) authorization (approval). We also suggest that you refer to United’s Provider Manual for an explanation of their out-of-network (approval) requirements and procedures, including your appeal rights if United denies a request for an out-of-network authorization. Nemours is working with United to minimize the impact of United’s out-of-network processes that we believe will make it challenging for Nemours’ providers to continue providing medical care to their existing patients with United coverage until they are able to transition to non-Nemours’ providers. However, effective immediately, all of Nemours’ Florida providers are NOT scheduling new patients or new courses of treatment for existing patients with United as their primary health insurance coverage for dates of service from April 1, 2014, forward unless United makes the appropriate advance arrangements with Nemours to provide the requested care. Of course, this termination will NOT change your United patients’ ability to seek emergency
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medical care after April 1, 2014, from any Nemours’ provider, including Nemours Children’s Hospital. If United does not provide your patient with an out-of-network authorization or out-ofnetwork referral for a Nemours’ provider and United also does not make the appropriate advance arrangements with Nemours to provide the requested services, United should provide you with the names of non-Nemours’ participating providers that have appointments available for your patients. United should also assist your patients in scheduling appointments with these non-Nemours’ providers and United should work with you to coordinate the transition of your patients’ care from a Nemours’ provider. If your patients have any questions regarding their options, we suggest that they contact United’s Member Services at (888) 216-0015. As many of our patients’ parents and guardians may also have questions about this termination, we have mailed the enclosed letter to the parents and guardians of our patients who we believe are enrolled in United. The enclosed patient letter contains additional details regarding this termination and we urge you to review it. We suggest that you consider sharing a copy of the enclosed patient letter with any of your United patients who may have questions. Since all of Nemours’ providers will be nonparticipating with United as of April 1, 2014, we anticipate that we will have very limited ability to assist you, or your patients, in resolving any issues that you, or your patients, may encounter in working with United. We sincerely regret the difficulties that you, or your patients, will experience in obtaining nonemergency medical care from Nemours’ providers as a result of this termination. Nemours values its relationships with both the physician community and its patients. We thank you for having had the privilege of caring for your patients and we will do our best to keep you updated as it relates to additional changes in our relationship with United. We’ve also enclosed the most recent list of insurance plans accepted at each Nemours’ location in Florida. In order to provide you with the most current information Nemours has regarding our relationship with United, we established a dedicated phone number that you may call for additional information. That number is (800) 767-5437. You may also email questions to
[email protected] or visit Nemours.org for more information.
Sincerely,
Mark N. Strong Managing Director, Managed Care The Nemours Foundation Attachment: Nemours’ letter to United Medicaid HMO and Healthy Kids Patients
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