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Phoenix Children's Hospital's ASC patients no longer covered under ACA plan: 4 key points

Health Net Ambetter, an ACA marketplace plan for Phoenix residents, will no longer cover patients seeking care at Phoenix Children's Hospital, according abc news.

Here are four key points:

1. All PCH services, inclusive of surgery centers, urgent care centers, physicians and laboratories, will be out of network for patients with the Health Net Ambetter plan, effective Jan. 1.

2. In October, Health Net sent a termination letter to PCH administrators, saying the plan was dropping the hospital and its services from coverage.

3. PCH Executive Director of Managed Care Renee Clarke said PCH was not provided a specific reason for the termination. Ms. Clarke said, "My assumption is they believe they can provide an adequate network with that contract."

4. Patients have the option of seeking care elsewhere or apply for special approval for care at the hospital. Also, patients can pay for services in cash; Ms. Clarke noted this third option is not feasible for some patients.

More articles on coding and billing:
Creating a competitive edge at your facility: The patient experience
5 key thoughts on out-of-network reimbursement with Collect Rx EVP Richa Singh
How to use price transparency to drive patient volume

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