PHOENIX — Editor's Note: Health insurer Aetna released this statement on Monday after it was unable to reach an agreement with Phoenix Children's Hospital.
"Phoenix Children’s Hospital is a valued partner in our efforts to provide our members with access to affordable, quality, convenient care that helps them achieve better health. Unfortunately, as of August 7, 2023, PCH is longer in network for Aetna. While we will continue to negotiate with Phoenix Children’s Hospital in hopes of keeping them in network, we have been unable to reach a new agreement due to their unreasonable and excessive rate increase demands, which would raise costs for our Arizona families and employers. Negotiating fair reimbursement rates is directly connected to our ability to keep costs affordable and maintain access to quality care for all our members.
Phoenix Children’s Hospital is obligated to honor the current in-network rates for 180 days following the termination or until the member’s employer coverage renews, whichever comes first. Members may also request Transition of Care benefits, which would allow them to receive care from PCH providers at in-network benefit levels for a specified time frame. Aetna Customer Service is available to support members needing to transition care to a new provider."
Original story:
Families whose kids rely on the specialized care at Phoenix Children's Hospital could be forced to find new doctors by the end of this weekend.
PCH and health insurer Aetna are locked in contract negotiations.
Many families might not know what's going on.
Melanie Ford, a kindergarten teacher who lives in Peoria, was surprised this week when she saw a statement on Aetna's patient portal telling insured families, "Phoenix Children's Hospital is no longer a part of your plan's network as of 08-07-23" – that's Monday.
"That was it. There was no information provided," she said in an interview Friday.
The statement urged patients to "Talk with your doctor if you're getting care or plan on getting care at this facility."
Ford believed she'd have to find new doctors immediately.
"I was stressing out," she said. "I have four kids, but two of them are on the Aetna insurance. They both have genetic, long-term for life heart conditions that need a specialist.
"We can't just stop going to the electrophysiologist."
Two of Ford's children, 13-year-old Ash and 12-year-old Hayden, have pacemakers because of a genetic heart problem.
Ash is undergoing transition therapy and gender care, Ford said, which is only provided at PCH.
"We have no other option but to utilize their services in network or out, which to me is screaming lots of financial bills," she said.
Ford had contacted me earlier in the week after she saw the statement on the patient portal. She wanted to know if it was accurate.
Three months ago, I reported on PCH's negotiations with another health insurer that left families in limbo even after the contract had expired.
But this case was different: The insurer was telling patients to look for a new doctor. Aetna gave no indication a new contract was being negotiated.
Within 24 hours, Aetna and PCH confirmed to 12News they were in the final days of negotiations on a new contract.
The deadline is midnight Sunday.
"I don't know who to blame," Ford said. "I feel like they're both probably a little bit money hungry."
Aetna is part of a health care and insurance behemoth after a $70 billion dollar merger with drug store giant CVS.
Phoenix Children's Hospital has launched a $400 million expansion across the Valley, buying up doctors practices and opening hospitals and clinics.
Aetna provided this statement to 12News on Thursday:
"Phoenix Children's Hospital is a valued partner in our efforts to serve our members with access to affordable, quality, convenient care that helps them achieve better health. We are hopeful that our current, active negotiations will result in a fair agreement that keeps Phoenix Children's Hospital in our network and serves the needs of members and employers in the Phoenix community."
Phoenix Children's Hospital provided this response:
"As Arizona's only comprehensive pediatric health system, Phoenix Children's is open and accessible to all children in our community. We are diligently negotiating so we can remain a participating provider with Aetna, however, contract changes must be made to better serve our patient families.
"As many families have experienced, denials of insurance claims are problematic and time-consuming. Given the ever-increasing costs of providing the high-quality care patient families rely on, Phoenix Children's can't afford to allow insurance companies to pay below the contracted rates by routinely denying services, and we cannot enter into an agreement that weakens our ability to serve our patients and families today, and into the future.
"We hope Aetna can address the issues currently preventing Phoenix Children's from renewing our contract."
PCH's statement on "denials of insurance claims" is similar to its negotiating stance with UnitedHealthcare three months ago.
The settlement of that contract was disclosed hours after the deadline.
Ford isn't looking for new doctors - yet.
"We're just kind of sitting around and waiting and trying not to think about it too much," she said.
"But at the same time planning. What's the next step?"