- Frequently Asked Questions
What is Ped-I-Care?
Ped-I-Care is responsible for administering the health insurance benefits for a group of children with special health care needs. It was developed to maintain a comprehensive provider network that offers community-based primary and specialty care, hospital and ancillary services; deliver and coordinate quality primary and specialty care, and; evaluate and continually improve the quality of service delivery, including participation in preventive care such as child health check-ups and participant satisfaction surveys.
How do I enroll in Ped-I-Care?
Members are enrolled through Florida KidCare and approved by Children's Medical Services. See "How Do I Apply?" for details.
If my child is assigned to Ped-I-Care is he/she still on CMS?
Yes, Ped-I-Care is a contracted program within CMS.
Can I use this insurance outside the state of Florida?
Yes, in an emergency, Ped-I-Care will cover out of state Emergency Room visits. Occasionally, we may also refer to an out of state provider due to a medical necessity.
What areas does Ped-I-Care serve?
Currently, we serve children in Alachua, Baker, Bradford, Citrus, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Hernando, Lake, Lafayette, Levy, Marion, Nassau, Putnam, St. John's, Sumter, Suwannee, Union, and Volusia counties.
What is a PCP?
Your PCP is your "Primary Care Physician". This pediatrician or family practitioner will be your child's main healthcare provider. Your PCP will provide all general healthcare, checkups and immunizations, and will coordinate referrals to any specialty care your child needs.
How do I change my PCP?
If you need to change your assigned PCP at any time, please contact Ped-I-Care Member Services at 352-334-1705 or 866-376-2456 (toll-free). We'll help you find another Primary Care Physician in your area. If the change is made by the 15th of the month it will be effective the 1st of the following month. However, any PCP changes requested after the 15th of the month will not be effective until the 1st of the month following the next. (For example: A PCP change made January 10th will be effective February 1st; but a PCP change made January 20th will be effective March 1st.)
How often can I change my PCP?
There is no limit as to how many times you can change your PCP. However, see above for limits on when the change will take effect.
If I change my child's PCP, what happens to my current referral?
If you have a current referral to a specialist, you may continue to go to that specialist. Please ask them to send your medical records to your new PCP so they will have the information if a new referral needs to be requested.
Do I have to use only University of Florida providers?
No. You may use any of the providers in our network. Ped-I-Care has developed a large network of primary care and specialty providers throughout the State of Florida both in private practice and at academic institutions such as the University of Florida and the University of South Florida. Please see your Provider Directory for a list of all current providers.
There is no in-network provider in my area; can I go to an out of network provider?
Yes, if it is deemed medically necessary and has been authorized by Ped-I-Care. Your PCP will obtain the needed authorizations.
What happens if I need to go to an out-of-network provider?
If your PCP determines that your child needs a service that is not available from an in-network provider, he/she will request an authorization. Once authorized, you can schedule your visit and get the needed services. So, please coordinate your visit with your PCP. If you go to an out-of-network provider without prior approval, you may be responsible for payment of those services.
My provider said that they don't know what CMS/Ped-I-Care is and they aren't sure if they are in-network providers. Who do they need to contact?
They can contact Ped-I-Care's Network/Provider Relations department at 352-334-1705 or 866-376-2456 (toll-free).
My provider wants to contract with Ped-I-Care so that my child can still receive services through them. Who should they contact?
Please have your provider contact our Network/Provider Relations department at 866.376.2456. We will be happy to speak to them about joining our network.
Does this insurance cover Emergency visits?
Yes, Ped-I-Care covers all emergency room visits.
Is there a co-payment?
There are no co-payments for any covered services. However, each member must make premium payments on time to Florida KidCare. See "Paying Your Premium" for details.
I received a bill, how do I get this paid?
Contact Ped-I-Care's Claims Manager at 352-334-1705 or 866-376-2456 (toll-free).
Can I get reimbursed for out-of-pocket expenses?
There are no out-of-pocket expenses for covered and authorized services. If you go outside the Ped-I-Care network for services without getting prior authorization, Ped-I-Care will not pay for those services, and you may be responsible for paying them. You may contact your local CMS office to ask about funding options.
I want to get my child a higher grade piece of equipment or supplies (such as eyeglasses, wheelchair, etc.) than what is covered by Ped-I-Care. Can I upgrade and pay the difference out of pocket?
No. If you request an upgrade from a covered item to an item that is not covered by Ped-I-Care we will not pay for it. However, if the upgrade is medically necessary, your doctor can request an authorization for the item, subject to review by our Medical Directors.
Do all services require referral/authorization?
No, please refer to your member handbook {link to MemberHandbook] for a list of services that will require referral/authorization.
Can I contact Ped-I-Care via email?
Because of privacy concerns we prefer to communicate with our members via phone, fax and mail. We can only communicate with our members via email if the member has read the Alert for Electronic Communications signed an Authorization for Electronic Communications found on the University of Florida Health Science Center's Privacy Office website.
Can I still use my Member ID card if any of the information is incorrect on it (i.e. misspelled name, wrong D.O.B, wrong SSN,etc.)?
No, please contact Ped-I-Care's Member Services if any information on your card is incorrect to get it corrected in our system. We will send you a new member ID card.
My child's name has been changed, how do I change it with Ped-I-Care?
Call Florida KidCare Member Services at 800-821-5437 (toll free) to make changes to any personal data. If you don't do this, there may be delays or problems with receiving your child's health care services. Click here for contact information.
My address has changed, how do I change it with Ped-I-Care?
Call Florida KidCare Member Services at 800-821-5437 (toll free) to make changes to any personal data. If you don’t do this, there may be delays or problems with receiving your child’s health care services. Click here for contact information.
I moved out of Ped-I-Care’s network can I still receive services through Ped-I-Care?
When you move you will need to contact Florida KidCare immediately. Depending on where you move, you may or may not be eligible for the Ped-I-Care program. If you aren’t eligible you will be directed to the program in your area that best fits your child’s health care needs.
If I’m not happy with services my child is receiving who can I contact about it?
You may contact either Ped-I-Care Member Services at 866-376-2456 (toll free) or your CMS Nurse Care Coordinator to report your concerns, questions, or issues regarding a provider.
Someone called me about a survey. What is it for and do I have to answer it?
Annually, a Member Satisfaction survey is done by the Institute of Child Health Policy at the University of Florida. They will ask you for your thoughts about the services your child receives and the Ped-I-Care program. The survey is voluntary, but your participation is greatly appreciated.
What is Ped-I-Care’s fax number?
Ped-I-Care’s fax number is (352) 955-6518.
Please make sure you mark your fax ATTENTION: to the person or department you are sending it to, so that it will get to the appropriate area.
How do I contact Florida KidCare?
Florida KidCare’s phone numbers are:
Applications: (888) 540-5437
Member Services: (800) 821-5437
