If you are considering changing insurance to a Marketplace or MMA (Medicaid) plan for any reason, please review the information below.
Marketplace Plans | Affordable Care Act (ACA)
We receive many inquiries regarding the ACA and whether we accept any of the marketplace plans. It is up to the managed care companies if they choose to include us in the network for any plan, and we are not always notified or given specific plan names. Even if we are contracted with a major managed care company (eg United HealthCare, Humana, etc.) that does not mean we are included in all of their plans, including marketplace plans. Each company can have hundreds of plans, and each of those plans can have different provider networks included.
TO DO: Check the participating providers listed for any plan you are considering. If our pediatricians are not listed, that means the plan has not included PHCA in their network.
- If PHCA is not listed on a plan you are considering, be aware that plan may have a narrow network that does not include a variety of providers. In addition the plan may not cover a full range of benefits and services, and may have hidden costs above and beyond the premium.
MMA (Medicaid) Plans
PHCA accepts only Amerigroup and Sunshine Health from the state MMA plans, and our offices are limited on the number of patients we can accept on those plans. Many of our offices have reached the maximum so their patient panels are currently closed to new patients; however see below for exceptions for established patient families on these plans. At this time only our Northside Office and Crossroads Office can accept new patients on Amerigroup and Sunshine Health.
Important! We do not accept the Amerigroup sub-plan called Florida Healthy Kids.
TO DO: ESTABLISHED PATIENTS
- If your family has an established patient at any office on Amerigroup or Sunshine Health, and you are pregnant or adopting, please contact your pediatrician's office regarding our sibling policy. Every effort will be made to accommodate siblings of established patients so you can stay at the same office.
- Established patients may stay with your current PHCA office if you change your insurance to Amerigroup or Sunshine Health for any reason. Please contact your PHCA pediatrician's office to provide new insurance information.
TO DO: NEW PATIENTS
- Be sure to select either or Amerigroup or Sunshine Health.
- At this time only our Northside (USF area) and Crossroads (St. Petersburg) locations can accept new patients on these plans. You may contact either office for your first appointment.
We hope you find this information useful when considering your options for health insurance.
If you have additional concerns about your insurance options and wish to contact your pediatrician's office, we will assist in any way we can.
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