CHOP and AmeriHealth Caritas, Keystone First reach new deal to avoid insurance disruption for thousands

The new deal arrives ahead of a June 30 final deadline when patients would have lost coverage for CHOP services under AmeriHealth Caritas plans.

The exterior of CHOP in Philadelphia

The exterior of CHOP in Philadelphia. (Children's Hospital of Philadelphia)

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Philadelphia’s busiest children’s hospital and the largest Medicaid health insurance provider in Southeastern Pennsylvania have reached a new contract deal, bringing relief to families and patients.

The agreement guarantees that children with health insurance from two plans under the AmeriHealth Caritas umbrella – Keystone First and AmeriHealth Caritas Pennsylvania – will continue to get treatment and services covered at Children’s Hospital of Philadelphia over the next couple years.

This avoids a disruption to insurance coverage and care for thousands of families, especially those who have children with complex and specialized medical needs.

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“We are appreciative for the collaboration between teams from both organizations,” CHOP and AmeriHealth Caritas officials said Wednesday in a joint statement. “Providing patients, members, and families with access to high-quality care is a shared priority, and we are proud to continue our efforts to serve our region’s most vulnerable children.”

Keystone First insures more than half of all Medicaid enrollees in southeastern Pennsylvania – nearly 504,000 children and adults,  according to state reports. AmeriHealth Caritas Pennsylvania is the largest provider in the Lehigh Valley and Harrisburg area, covering about 39% of enrollees.

Contracts between hospitals and insurance plans outline which health care services will be covered and for how much. That coverage eventually gets handed down to patients in the form of covered in-network services and billing.

In March, CHOP began notifying families and patients that if they could not reach a new deal with the health insurer, services would no longer be in-network after June 30.

This would have left some families with a tough choice: keep their current insurance plan and seek out new health providers elsewhere or stay at CHOP and try to switch to new health plans.

A group of parents created an online petition urging the parties to reach a deal. The petition eventually garnered more than 2,800 signatures.

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Local representatives also weighed in. State Rep. Paul Friel, a Democrat who represents Chester County, wrote in a May 3 letter that the loss of a contract and covered services would have a detrimental impact on many families in the area.

“History has shown that prolonged stand-offs between health care entities have severe consequences,” Friel stated. “The longer these disputes persist, the greater the harm to patients, families, and all involved parties.”

After months of negotiations, the hospital and insurer reached a multi-year contract that will replace the current agreement, which expires at the end of June.

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