On August 7 at 12 a.m. officials with Phoenix Children’s announced that their agreement with a major health insurance provider has ended, leaving many families at a loss for the care they were dependent on.
This means for many children in the care of Phoenix Children’s hospital, there insurance will now be considered out of network for Aetna policyholders, which will make their medical costs significantly higher.
Phoenix Children’s shared the statement Monday afternoon:
“Phoenix Children’s can confirm its current agreements with Aetna expired on August 7, 2023. The contracting process can be difficult and can cause uncertainty, especially for our patient families who rely on the expert care Phoenix Children’s provides at our 40 sites of service throughout Arizona.
We will continue to work diligently with Aetna to reach an agreement that addresses the significant number of routine denials, and one that supports the expanded, expert care we provide to children and their families throughout our community.”
Many families are left feeling very stressed and angry. For those who are dependent on regular care from the hospital specialists and medical teams, they don’t have anywhere else to go. Families are now left scrambling trying to figure out their next step to care for their children or figure out how to pay for the significant increase in the cost of care.
This isn’t the first time in recent months that Phoenix Children’s Hospital has been under the pressure of working with insurance companies. The hospital reached a deal at the last minute to continue coverage with United Healthcare in June.
Experts say they have seen the trend across the country of hospitals and insurance companies. It is a widespread problem that doesn’t seem to be going away.
So what exactly happened? As of on Aug. 6, Phoenix Children’s agreement with Aetna expired and at that point the hospital is no longer considered to be an in-network provider of Aetna coverage. Meaning that if you have Aetna insurance and your child is treated by Phoenix Children’s, families will be responsible for paying more. Although Aetna plans serving those with Medicaid will not be impacted.
Out-of-network means Aetna has a group of health care providers, including doctors, specialists, dentists, hospitals, surgical centers, and other facilities who have a contract with. As part of their contract, they provide services to their insurance members at a certain rate. This rate is an agreed upon much lower rate than what they would charge if the patient was not an Aetna member. An “out-of-network” provider does not contract with the insurance company an usually charge a rate that is higher than an Aetna plan recognizes.
Phoenix Children’s Hospital is working to reinstate their partnership with Aetna. At this time, it is unknown how long they may be out-of-network.
