Frustrated families waiting for agreement between Aetna and ... - ABC15 Arizona in Phoenix

PHOENIX — It's now been more than a month since the contract between insurance provider Aetna and Phoenix Children's ended.

Local families are still left in limbo as a result.

"I'm still very, very stressed out about it all," said Susan Harris.

She's been anxious since the end of July, when Harris received an email informing her Aetna and Phoenix Childern's were days away from their contract ending.

Harris' now 19-month-old son Kolton has had several surgeries and gets frequent therapy at the hospital.

"It's almost like I've given up hope that a resolution is gonna get resolved at this point, and I've had to look elsewhere," said Harris.

When the contract ended on August 7, Aetna originally told ABC15 Phoenix Children's would have to honor in-network rates for 180 days.

They also said parents could apply for transition of care benefits.

But when ABC15 reached out to Phoenix Children's, the hospital said they were told certain patients approved by Aetna would get in-network rates and only for a short period of time.

"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 many of these in-network patient access requests," said Phoenix Children's in a statement to ABC15.

For now, Harris has decided instead to use other therapy providers in-network.

"I assume we won't have any coverage after the 90 days," said Mackenzie Cruz, a mom of three.

The Cruz family from Mesa said they were approved for 90 days of in-network rates at PCH.

In August, the family was just days away from their toddler's eye surgery when ABC15 reached out to Aetna about their situation.

The family also had another specialist appointment for their oldest son.

"We were able to get into the surgery, and we had a follow-up appointment, and we should be covered for another one next month," said Cruz.

Cruz told ABC15 that in-network coverage does not include pediatrician or Urgent Care visits.

Both families feel frustrated and are left with little hope a deal will be reached.

"There's been no follow up," said Cruz. "So at this point, it seems it might not ever happen, and it's best to just switch insurances."

"These are our children, and they are worth more than just that last dollar or penny that it's coming to," said Harris.

ABC15 reached out to Aetna multiple times Friday for an update but did not hear back.

A request was also sent to Phoenix Children's for an update on where negotiations stand, but no response has been received yet.

Phoenix Children's gave the following statement to ABC15:

"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, Aetna has informed Phoenix Children's that only certain patients approved by Aetna will be treated as in-network for a short period of time, 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 many 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."

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