No deal: Aetna drops Phoenix Children’s Hospital, negotiations continue

PHOENIX (3TV/CBS 5) -Many families across the Valley are disappointed after Aetna dropped Phoenix Children’s Hospital on Monday. The deadline of Sunday at midnight came and went with no deal. This comes after the major insurance company and hospital system could not come to an agreement before the prior contract expired today.

In June, Phoenix Children’s found common ground with another leading insurance company, United Healthcare, just in time. But that’s not the case this time.

This news is causing panic for many local families. Both Aetna and Phoenix Children’s said they’re still working to come to an agreement, but as of Aug. 7, the hospital is no longer in-network for those insured by Aetna.

The Erikson family is frustrated. “It kind of feels like we’ve been kind of abandoned at that point,” said Megan Erikson. Megan and Bobby’s young children see specialists at Phoenix Children’s Hospital.

After Aetna dropped PCH from its network, these parents aren’t sure what to do. Their daughter has ear surgery coming up this month. “It’s already stressful enough dealing with the specialists and the procedures and that surgery my daughter has to have. So, having to do, get all of these forms filled out on top of it is not fun,” said Bobby Erikson.

Those forms he’s referring to are for Transition of Care benefits. If Aetna approves, the Eriksons and other qualifying families may still receive in-network rates for a period of time at PCH. “It just feels really unfair that we pick a plan to start the year, and we know providers are in-network, and then to have it just changed in the middle of the year with no control over it,” said Bobby.

Mom Julie Thompson is worried. Arizona’s Family first spoke with her last week. She wonders how much it could cost to pay for care out-of-pocket. Her daughter Addilyn sees a neurologist at Phoenix Children’s. “Is it doable? Can she continue seeing the doctor that she’s formed a strong relationship with or do we have to start from scratch?” said Thompson.

The Eriksons said they could likely switch insurance companies during open enrollment next year by going through Megan’s employer instead, but that’s not a big help right now, and their daughter may have to wait a while for her surgery.

PCH created a website to help families navigate this change. Arizona’s Family reached out to both organizations. You can read their full statements below.

“Phoenix Children’s Hospital is a valued partner in our efforts to provide our members with access to affordable, quality, convenient care that helps them achieve better health. Unfortunately, as of August 7, 2023, PCH is longer in network for Aetna. While we will continue to negotiate with Phoenix Children’s Hospital in hopes of keeping them in network, we have been unable to reach a new agreement due to their unreasonable and excessive rate increase demands, which would raise costs for our Arizona families and employers. Negotiating fair reimbursement rates is directly connected to our ability to keep costs affordable and maintain access to quality care for all our members.
Phoenix Children’s Hospital is obligated to honor the current in-network rates for 180 days following the termination or until the member’s employer coverage renews, whichever comes first. Members may also request Transition of Care benefits, which would allow them to receive care from PCH providers at in-network benefit levels for a specified time frame. Aetna Customer Service is available to support members needing to transition care to a new provider.”
Aetna Insurance Spokesperson

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