This week, Phoenix Children’s Hospital is notifying patients and families that for the first time the hospital will not be covered by the Affordable Care Act marketplace insurance plan.
Beginning Jan. 1, 2018 all PCH services including doctors, surgery centers, urgent care centers and laboratories will be considered out of network for patients with the Health Net Ambetter plan. Health Net is the only insurance provider in the Obamacare marketplace in Maricopa and Pima counties. Ambetter is Health Net's insurance package for ACA consumers.
Health Net sent a termination letter to PCH administrators in October, notifying them the hospital would be dropped from coverage, a PCH spokeswoman said. PCH has been part of ACA marketplace coverage since the law was enacted.
“We were obviously disappointed when they chose to remove us from the network,” said Renee Clarke, the executive director of managed care for PCH. “We weren’t given a specific reason but shortly after they issued the termination they announced a three-year deal with Banner Health so my assumption is they believe they can provide an adequate network with that contract.”
It’s unclear how many patients at Phoenix Children’s Hospital will be impacted by the change.
Camille Calvert of Carefree just learned about the change when she visited Healthcare.gov to renew her son’s ACA coverage for 2018.
“We don’t know what’s next, that’s the really frustrating part,” said Calvert, a mother of three.
Calvert and her husband have relied on PCH services for their nine year-old son Crewe since he was born. Crewe was born with a cystic hygroma, a lymphatic malformation that causes severe swelling and cysts to grow in his airway. He requires ongoing, expensive medical treatment.
Camille says she didn’t realize PCH was dropped by Health Net until it was too late.
“We’ve passed the open enrollment period for my husband’s new job where he could have been put on that insurance. We don’t know what we’re going to do,” Camille said.
Families who have questions about the future of their child’s care can contact the Health Net Customer Contact Center at 1-800-289-2818.
PCH will send letters to about 1,000 patients who have used PCH services under Obamacare coverage within the last six months, many whom would likely require follow-up visits. Patients who cannot be treated elsewhere will have the option to apply for special approval that may allow for continued care at PCH.
“We know there are a lot of conditions that we (PCH) are the only one in the state that can treat -- there are no other subspecialists who can handle these conditions. And so that’s what we are still trying to quantify on our side,” Clarke said.
Patients with very rare conditions usually receive approval for continuity of care, Clarke said.
Emergency room care at PCH will also continue to be covered, as required by the ACA, and out of network benefits may apply.
The third option for families who have relied on PCH is simply to pay for services in cash, Clarke said.
“We know that is not be an option for a lot of families,” Clarke said.