PHILADELPHIA (KYW Newsradio) — Leslie Proffitt’s daughter, 14-year-old Lily Ciechoski, has been a patient at the Children’s Hospital of Philadelphia for most of her life, as she was born with spastic quadriplegic cerebral palsy and epilepsy.
Also for most of her life, Proffitt said her daughter has been on the Keystone First health insurance plan. However, Proffitt and other families fear they could lose some of their insurance coverage because Medicaid may no longer keep CHOP as an in-network provider.
CHOP is “currently a participating provider of AmeriHealth Caritas PA and Keystone First,” it said on an information page for affected patients. “However, those contracts will end July 1, 2024, unless a new agreement is signed before that date.”
If contract negotiations fail, CHOP will no longer be considered an in-network Medicaid provider through AmeriHealth Caritas PA and Keystone First.
“If they decide that they’re going to not come to an agreement with CHOP, we’ve got to make the decision to switch insurance plans, which might sound easy but it’s not an instantaneous thing,” said Proffitt. “We see CHOP for a variety of specialists, so that’s going to be a huge issue. The switch for insurance plans like that can take weeks.”
After Proffitt and other affected parents petitioned lawmakers, two dozen Pennsylvania state House Democrats issued an open letter — penned by Chester County state Rep. Paul Friel — that calls on insurers to “find a solution that maintains CHOP’s inclusion in the network.”
Removing CHOP from the networks would create barriers to crucial health care for children with disabilities and from low-income families, they said.
“There’s a lot of things that Keystone First provides that Aetna doesn’t consider medically necessary, like diapers,” Proffitt added. “They don’t find that medically necessary. They won’t pay for it.”
The lawmakers wrote in their letter: “Failure to reach an agreement would result in disrupted care for thousands of young and sick patients. Families who are already navigating the complexities of the medical system would face additional challenges. For children with severe chronic conditions, unique disorders, and special needs, finding an alternative provider with the necessary expertise would be an uphill battle. Moreover, since the affected patients are covered through Medicaid, the consequences are even more pronounced, as fewer practices are available to many of these children due to their parents’ income limitations.”
Keystone First said in a statement that negotiations are active, and it put the onus on CHOP to choose to remain in-network. In another statement, CHOP said it is in contact with potentially affected families, and if no agreement is reached, it will work with those families to avoid disruptions in care.
CHOP is considered in-network with all other Pennsylvania Medicaid plans.