Some Blue Cross Blue Shield Arizona patients to lose coverage at Phoenix Children's

Some Phoenix Childrens patients to lose coverage

If your health insurance is with Blue Cross Blue Shield Arizona, you might lose coverage if you need to visit Phoenix Childrens Hospital. In-network coverage, for some plans, at PCH ends on Oct. 31.

PHOENIX - If your health insurance is with Blue Cross Blue Shield Arizona, you might lose coverage if you need to visit Phoenix Children's Hospital.

In-network coverage, for some plans, at PCH ends on Oct. 31.

"Phoenix Children’s has given notice of its intent to leave the network effective October 31, 2024. We worked hard to keep them, but so far they have said no," the insurer said in an Oct. 30 news release on its website. "Without a change, which at this point we do not anticipate, Phoenix Children’s will be out of network effective October 31, 2024."

Emergency room visits will still be covered in-network, and so will those who are in the middle of treatment.

The insurer says not all plans will be impacted by the change. Click here to learn more about which plans are impacted.

"The corporate negotiating team at Phoenix Children’s Hospital let AZ Blue know that a $50 million raise is not enough to continue caring for AZ Blue members and their children," the company's website said.

On PCH's website, it describes the reason for the change in coverage as, "We are working to remain in-network with BlueCross BlueShield but have not reached a new agreement yet. Phoenix Children’s is focused on reaching an agreement that allows us to continue providing the highest quality of care to our growing community as patient families deserve exceptional pediatric care close to home."

The hospital says if you have an appointment scheduled after coverage ends on Oct. 31, "you may qualify for Continuity of Care or Transition of Care in-network benefits for a short period of time if your child needs ongoing treatment for a specific illness or medical condition only. For any questions about your BlueCross BlueShield Continuity of Care or Transition of Care benefits coverage, call the customer service phone number on the back of your health insurance card."

The insurer on its website said it's going to continue negotiations with the hospital.

"We love PCH and the care their teams provide to Arizona’s kids and their families. We are doing our best to keep them in our network. We are awaiting a counter proposal from PCH’s corporate negotiating team but have not received one to date. With only two weeks until the PCH-imposed deadline of October 30, it looks like they intend to leave the AZ Blue network," the company said, in part.

Phoenix Children's released a statement saying, in full:

"Phoenix Children’s is open and accessible to care for all children, and we continue to add new sites of service to meet the needs of our growing community. We are working diligently to negotiate with BlueCross BlueShield, but the contract must be updated to best serve the children in our care. Here is how we are working to protect our patient families.

BlueCross BlueShield denies more than 10% of claims submitted by Phoenix Children’s, resulting in annual reductions of $21 million and growing. To address this high denial rate, we are asking BlueCross BlueShield to agree to a review by a qualified, independent pediatric physician before denying services or payment.

We are also asking for contract terms that prevent BlueCross BlueShield from making unilateral changes to our agreement without our consent. A recent unilateral contract change by BlueCross BlueShield in August of 2024 regarding a fee schedule resulted in a significant reduction in payment for services without our agreement.

According to national news reports, the BlueCross BlueShield Association recently agreed to pay a $2.8 billion legal settlement and change its business practices because of the operational challenges they were creating for providers like Phoenix Children’s and our patients.

Phoenix Children’s is seeking a reasonable rate increase to keep up with the cost of medical care and to align with industry standards. BlueCross BlueShield’s offer is significantly lower than reported and represents an aggregate annual rate increase of 4% after adjusting for high denial rates.

Misinformation on the rate increases offered to Phoenix Children’s is designed to alarm families and distract from the important conversation surrounding high quality pediatric health care. Phoenix Children’s cannot enter into an agreement that weakens our ability to serve Arizona families now and in the future. We appeal to BlueCross BlueShield to address these issues before our contract ends today at midnight.

We also want our patient families to know they have options available for in-network care, and we encourage them to take advantage of open enrollment opportunities."