Phoenix Children's and insurer Aetna's agreement expired at 12 a.m. Monday, August 7.
If the deal expires all Phoenix Children’s care will be considered out of network for Aetna policyholders, meaning medical costs will be higher.
Phoenix Children's shared a statement Monday afternoon, following the decision to terminate its contract with Aetna which could impact Valley families.
Full statement below:
“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.”
ABC15 spoke with Susan Harris on Sunday, "It's extremely stressful. I'm pissed off."
Harris takes her 18-month-old son Kolton to Phoenix Children’s at least once a month.
“I have two upcoming appointments just this next week,” Harris said.
At the end of July, Harris got a notice from Aetna informing her Phoenix Children’s would be out of network on August 7, with no mention of ongoing negotiations.
With Kolton’s doctors and specialists at Phoenix Children’s, Harris doesn’t want to have to go elsewhere.
“Having everything under one roof that knows my son knows his medical records knows everything is paramount I think to his development and his care,” Harris said. “I’ve got to figure out how to pay out of network and that’s not something financially I’m set up to do.”
This is the second time in months that Phoenix Children’s has come down to the wire with a major insurer. The hospital reached a deal with United Healthcare in June.
Experts say it is part of a larger trend of hospitals and insurers walking up to hard deadlines.
“It is not just with Phoenix Children’s, not just with Aetna, but it's a wide widespread problem,” Redirect Health Chief Medical Officer Dr. Janice Johnston said.
“I would want to tell them it’s not worth the stress you two are putting on families for whatever is coming down to the wire. It shouldn't come down to the wire,” Harris said. “I will fight for my kids, 100%. And this needs to get worked out tonight. I don’t want to cancel the two appointments we have coming this next week while it gets haggled.”
Aetna told ABC15 in a statement:
"Phoenix Children’s Hospital is a valued partner in our efforts to serve our members with access to affordable, quality, convenient care that helps them achieve better health. We are hopeful that our current, active negotiations will result in a fair agreement that keeps Phoenix Children’s Hospital in our network and serves the needs of members and employers in the Phoenix community."
In a statement, Phoenix Children’s says:
“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.”
