Phoenix Children’s Hospital may be dropped by insurance company if agreement isn’t reached

PHOENIX (3TV/CBS 5) - It’s been about a month since Phoenix Children’s Hospital was down to the wire to reach an agreement with United Healthcare. Now, another major insurance company, Aetna, may soon be out-of-network if a deal isn’t reached by Sunday at midnight.

Seven-year-old Addilyn Thompson has dealt with cyclic vomiting syndrome for most of her life. “She vomits 10-15 times a day, if not more. She cannot eat, she cannot drink, and usually it happens for days on end, sometimes up to a week. It will just continuously happen before she is able to finally recover and then resume her life again,” said her mother, Julie Thompson.

Thompson said all of Addilyn’s symptoms are under control thanks to the proper dosage of medication prescribed by her neurologist at Phoenix Children’s Hospital. Now she worries her Aetna insurance may soon be out-of-network due to ongoing negotiations between the hospital and insurance company. “I had a little bit of a panic mode kick in about what are we going to do,” she said.

Thompson first learned about the contract dispute through a letter from Aetna a few days ago. It let her know that her daughter’s neurologist may soon be out-of-network, and another letter she got from Aetna just last night said all of Phoenix Children’s might be dropped as soon as Monday.

“Through Children’s I have to book appointments six months in advance just to get in to be seen. Specialists are hard to get into. And so I don’t know now if I’m even going to be able to make it. Am I going to be able to find somebody else in time for her next appointment for her medications if this doesn’t go through?” said Thompson.

We did reach out to both Aetna and Phoenix Children’s about this. The hospital said these negotiations do not impact emergency care and is still available to patients regardless of insurance.

Below is the statement from Phoenix Children’s:

“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.”
Phoenix Children's Hospital

Here is the statement from Aetna:

“I find it really irresponsible of Phoenix Children’s that they did not reach out to any of the families that are impacted by this to let them know in advance so that we’d have enough time to seek alternative care,” said Thompson.

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