PHOENIX — Valley parents are left waiting to see what kind of coverage they will receive, as negotiations between Phoenix Children’s Hospital and insurance provider Aetna continue.
“It’s definitely stressful,” said Mackenzie Cruz.
She and her husband Timothy Cruz tell ABC15 they have felt that stress for days, after learning about the situation between Aetna and Phoenix Children’s.
“All they said was they no longer work with Phoenix Children's, and that we needed to have a new provider starting Monday,” said Mackenzie.
The agreement between Aetna and the Arizona hospital ended at midnight Monday, days before two of the three Cruz children have appointments.
The Valley couple’s middle son, three-year-old Carter, has an eye surgery planned.
“I was really nervous as soon as we found out because [Carter] has a surgery scheduled next Friday,” said Mackenzie. “Then Jacob, my son, has an appointment coming up next week as well for his Celiac Disease."
Mackenzie said she has been on and off the phone with Aetna for days trying to figure out their options.
The family says they are still hoping to still get in-network coverage.
"We really don't need a huge extension," said Mackenzie. "We just need to get through the surgery next week and the follow up appointment."
But even more time would be helpful to her family.
Aetna told ABC15 in a statement that Phoenix Children's does have an obligation to honor the current in-network contract rates for, "180 days following the termination or the member’s employer coverage renews, whichever comes first."
"We haven't heard anything about 180 days," said Mackenzie. "We got a message from Phoenix Children's telling us to just reach out to Aetna to figure something out, and Aetna I mean they've given us the option of giving us the transition of care form or finding a new doctor."
Mackenzie says she has filled out that form, but now the family is left waiting.
Phoenix Children's does have a webpage dedicated to this developing situation.
The hospital says emergency care will not be impacted, and some patients may be eligible to receive continuity/transition of care benefits.
The hospital is encouraging families to contact Aetna as negotiations continue.
As of Tuesday night, a deal has not been reached.
In the meantime, the Cruz family told ABC15 they have been told out-of-network care could be significantly more expensive.
But Mackenzie said, right now, the family is holding out hope and continuing on with their appointments as planned
"We have filled out everything, and we are going to go forward with it as its expected because we know it's the best thing for our son," said Mackenzie.
On August 17, Phoenix Children's provided the following update:
Phoenix Children’s is no longer an in-network provider with Aetna as of August 7, 2023. While Aetna has cited it will honor in-network rates and patient access at Phoenix Children’s for a short period of time, it has not communicated this process and what is required, creating significant confusion for families.
Our clinicians are working hard to help patient families seek in-network access and continuity of care benefits with our many specialists, surgeons and providers, but Aetna is delaying and or rejecting nearly all of these in-network patient access requests. We are committed to fighting for our patients and holding Aetna accountable and we encourage patient families to contact Aetna today for answers regarding their benefits.
