Questions linger why Phoenix Children's Hospital was dropped from ACA coverage

Phoenix Children's Hospital not covered in 2018 Affordable Care Act, leaving families and children without health care.

It remains a mystery why the county’s sole provider of health insurance for the Affordable Care Act marketplace severed ties with Phoenix Children’s Hospital in October.

As 12 News first reported Monday, insurance provider Health Net dropped the popular children’s hospital from Obamacare coverage in 2018 and added Banner Health to its pool of healthcare providers. The move means hundreds of children who suffer from a range of health conditions and illnesses currently being treated at PCH will transition to new doctors and specialists next year. 

Decisions about whether to renew agreements with hospitals are typically made after negotiations, said Monica Coury, Health Net's vice president of legislative and government affairs, during a phone interview with 12 News on Thursday. However, Coury declined to discuss the specific reason why PCH was dropped. She said “communication remains open” with the children’s hospital.

 “Our medical management team is reaching out to members currently receiving care at Phoenix Children’s Hospital to ensure a safe transition,” said Coury in a separate statement provided to 12 News. 

A spokesperson for Phoenix Children’s Hospital says Health Net’s termination was “a unilateral decision” and PCH was not given an opportunity to negotiate at all.

For families affected, the transition means that during a time marketplace costs are going up under the Affordable Care Act there will be an additional hassle of moving to new pediatric providers. 

“Health Net of Arizona is committed to connecting our members with doctors, facilities and hospitals that provide quality care at an affordable cost,” Coury said.

Some families may find they have more options because although Health Net dropped PCH, it is adding the prominent Banner Health to its repertoire of medical providers, bringing an overall addition of 75 primary care physicians, 1,450 specialists and 4 acute hospitals, according to Coury. Nearly all services offered at PCH will now be offered at Mesa’s Banner’s Cardon Children’s Medical Center, she said.

However, there are some services only PCH offers.

“We will work with all of our members who are in need of care that may only be provided by PCH,” Coury said in the statement. In addition, all Ambetter members will still have access to Phoenix Children’s emergency room.

Anyone with questions about the changes should contact Health Net's Customer Contact Center at 1-800-289-2818. Telecommunication devices for the deaf may be accessed by calling 1-800-995-0852.

© 2017 KPNX-TV


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