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ACA Provider Ambetter Drops Phoenix Children's Hospital

Families who rely on the Affordable Care Act for their child’s health care are finding out one Valley hospital will soon be considered “out of network.”

Phoenix Children’s Hospital is considered one of the best places to take a sick child.

"We have somethings that are very specialized that only we offer. So these families are of course concerned their children will not get the care that they need," said Doug Meyers, PCH's chief financial officer.

He says that in October, staff learned that the only ACA provider in Maricopa County, Health Net’s Ambetter program, would no longer contract with PCH,  leaving some families without access to the hospital starting Jan. 1.

Meyers says around 1,000 families have been notified by Health Net and PCH would be sending notices as well. But it doesn’t end there.

Renee Clark is PCH’s executive director of managed care. "If a member needs services at Phoenix Children’s Hospital they have to get special approval to be seen here, so it’s not as simple as saying I’m going to opt to use my out of network benefits and pay more, they don’t even have that option," Clark said.

That’s because Ambetter is an HMO, she said. Meyers said PCH will try to find alternative ways to cover patients, which could include getting some of them on Arizona's Medicaid, the Arizona Health Care Cost Containment System. 

KJZZ senior field correspondent Kathy Ritchie has 20 years of experience reporting and writing stories for national and local media outlets — nearly a decade of it has been spent in public media.