Phoenix Children's Hospital will not be covered by ACA insurance in 2018

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Starting next year, Phoenix Children's Hospital will be considered "out of network" for patients covered by Health Net's Ambetter program. (Source: 3TV/CBS 5) Starting next year, Phoenix Children's Hospital will be considered "out of network" for patients covered by Health Net's Ambetter program. (Source: 3TV/CBS 5)
PCH's CFO Doug Myers says Health Net gave them no reason why it decided to terminate. (Source: 3TV/CBS 5) PCH's CFO Doug Myers says Health Net gave them no reason why it decided to terminate. (Source: 3TV/CBS 5)
Becky Griefer is going to have choose a different hospital for her son. (Source: 3TV/CBS 5) Becky Griefer is going to have choose a different hospital for her son. (Source: 3TV/CBS 5)
Griefer has C.J. insured by Health Net's Ambetter program through the health insurance marketplace. (Source: 3TV/CBS 5) Griefer has C.J. insured by Health Net's Ambetter program through the health insurance marketplace. (Source: 3TV/CBS 5)
PHOENIX (3TV/CBS 5) -

A big shakeup in Arizona health insurance. 

The only Obamacare provider in Maricopa County will no longer be covering trips to one major Valley hospital. 

Starting next year, Phoenix Children's Hospital will be considered "out of network" for patients covered by Health Net's Ambetter program

At 10 years old, C.J. Griefer's gotten used to the needle pricks and the blood sugar testing that come with his Type 1 diabetes.

"You have to get enough blood," C.J. said, narrating his routine. "I do this every night" 

Now he and his mother Becky Griefer are going to have to get used to using a new hospital. 

PCH has always been her first pick when her daughter needed care. 

"It's an amazing hospital system dedicated to children, we've seen them in action three times," Griefer said.

Griefer has C.J. insured by Health Net's Ambetter program through the health insurance marketplace. It costs her $400 a month, nearly $1,100 cheaper than the insurance offered by her employer.

But starting Jan. 1, 2018, Health Net will be dropping PCH from its coverage. 

"When you have a child who's sick and you are looking at his future, thinking it's quite likely that he will go into the hospital again, and you don't know when or where, options are extremely important," said Griefer. 

PCH's CFO Doug Myers says Health Net gave them no reason why it decided to terminate.

"We have the most comprehensive pediatric care in the state so many patients may lose access to us so we're surprised and saddened by this," said Myers.

Health Net of Arizona sent us a statement regarding this decision, saying: 

"Health Net of Arizona is committed to connecting our members with doctors, facilities and hospitals that provide quality care at an affordable cost. This change impacts Ambetter from Health Net, our marketplace program. Ambetter from Health Net is pleased to announce an overall addition of approximately 75 Primary Care Physicians, 1,450 Specialists, and 4 more acute care hospitals with the addition of Banner Health to the Ambetter network. Banner, Honor Health, Abrazo Community Health Network, Iasis Health Care, Maricopa Integrated Health System and many other hospital and physician partners are prepared to support the health care needs of our members and provide the highest quality care. Our medical management team is reaching out to members currently receiving care at Phoenix Children’s Hospital (PCH) to ensure a safe transition. All of our Ambetter members will still have access to Phoenix Children’s emergency room. Nearly all of the services offered at PCH are also offered at Banner’s Cardon Children’s Medical Center, but we will work with all of our members who are in need of care that may only be provided by PCH. 
 
Our Customer Contact Center is available to assist members Monday through Friday from 8:00 a.m. to 6:00 p.m., at 1-800-289-2818. Our Telecommunication Device for the Deaf may be accessed by calling 1-800-995-0852. We encourage any Ambetter from Health Net member to call us with any questions regarding their care."

About 1,000 patients could be affected. PCH is working to notify all of them.

"I think that companies need to put people first instead of profits," said Griefer. 

PCH has been covered under marketplace insurance since the beginning. This will be the first year it won't be covered. 

"If they want Phoenix Children's Hospital to be part of Ambetter, they should call Health Net and voice that, tell them that they want PCH to be part of that network," said Myers. 

PCH says there might be some exceptions, like emergency rooms visits, that could still be covered. 

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Lauren ReimerLauren Reimer joined the 3TV/CBS 5 family in June 2016. She is originally from Racine, WI but is no stranger to our heat.

Click to learn more about Lauren.

Lauren Reimer

She previously worked for KVOA in Tucson, covering topics that matter to Arizonans including the monsoon, wildfires and border issues. During the child migrant crisis of 2014, Reimer was one of only a handful of journalists given access to the U.S. Customs and Border Protection detention facility in Nogales, where hundreds of unaccompanied children were being held after crossing into the U.S. from Central America. Before that, Reimer worked at WREX in Rockford, IL. Lauren is a graduate of the University of Wisconsin - Milwaukee and still visits home often. When not chasing news stories, Reimer loves to explore, enjoying everything from trying new adventurous foods to visiting state and national parks or local places of historical significance.

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