Most AHCCCS Children’s Rehabilitative Services (CRS) participants will be enrolled in one of the seven AHCCCS Complete Care (ACC) plans beginning October 1, 2018. Members of ACC plans have the option of receiving care from any community provider who has signed a contract with their ACC plan as an in-network provider. Five of the seven ACC plans, including Care 1st, Steward Health Choice Arizona, Banner University Family Care, Mercy Care, and UnitedHealthcare Community Plan, have contracted with Phoenix Children’s as an in-network provider. Phoenix Children’s Hospital is continuing to work with the other ACC plans to ensure that its services and facilities are covered by these plans.
Does Phoenix Children’s hospital accept Blue Cross Blue Shield?
Phoenix Children’s Hospital and Blue Cross Blue Shield of Arizona (BCBSAZ) have announced the signing of a new deal. Phoenix Children’s will remain an in-network provider for BCBSAZ members and their families under the new arrangement.
“Phoenix Children’s President and CEO Robert L. Meyer stated, “Patient families deserve exceptional pediatric care close to home.” “Phoenix Children’s will be able to continue providing the greatest quality of care to our growing community under this new contract.”
“Blue Cross Blue Shield of Arizona and Phoenix Children’s Hospital have a long-standing partnership, and together, we will continue to provide care to children and families throughout Arizona,” said Pam Kehaly, President and Chief Executive Officer of Blue Cross Blue Shield of Arizona. “The amended agreement reaffirms our commitment to ensure that our members and their families have timely access to the treatment they require.”
For BCBSAZ members, the new agreement covers a wide range of Phoenix Children’s services, including inpatient and outpatient care, physician and ancillary providers, imaging, laboratory tests, surgery, emergency department care, specialty and urgent care centers, and other Phoenix Children’s facilities and services.
Does Phoenix Children’s hospital charge patients?
You should concentrate on helping your child get better while he or she is in the hospital or seeing a specialist. We understand that medical bills can be stressful, and we’d like to assist you by offering information and answers to the most common billing questions.
What is a deductible?
A deductible is the amount you must pay before your insurance company begins to cover part or all of your medical costs. Confirm the amount of your deductible by checking your insurance coverage details. Any hospital treatment, including hospital stays, specialty and urgent care, and outpatient visits conducted at Phoenix Children’s associated sites, may be subject to deductibles.
What is co-insurance?
Co-insurance is a defined percentage of the insured medical expenses you may be expected to pay after you’ve met your deductible. Confirm your co-insurance % by reviewing your insurance coverage details.
What is a co-payment?
This is a pre-determined payment you make each time you receive medical treatment, based on your insurance coverage. Confirm the amount of your co-payment, which is due when you receive services, by checking your insurance coverage details.
Can I get an estimate of what services will cost before my visit?
Yes, our Pre-Access Department can provide you an estimate of how much medical treatments will cost ahead of time. Our Financial Counseling Department can give this information for nonscheduled services if you receive treatment in the Emergency Department.
Why are some of my hospital bills covered by insurance and some are not?
Before full coverage applies, most hospital plans include a deductible or out-of-pocket expense that you must pay. Because each insurance plan is unique, please carefully evaluate your benefits and contact your insurance company if you have any questions about coverage or expenses that are covered.
If my child spends the night in the Hospital, will I be charged as an inpatient?
Your physician may decide that an evaluation of your child’s condition is necessary, or that an inpatient admission to the hospital is necessary. Despite the fact that your child may be staying in the hospital overnight, he or she is an outpatient. Your insurer will pay on an outpatient basis as an Observation Status patient, and you may be responsible for any out-of-pocket charges such as co-payments and deductibles, depending on your specific insurance plan. If your physician believes that your child needs to be admitted to the hospital as an inpatient at a later time, we will advise you of the change in status from outpatient to inpatient.
Why did I get multiple bills for my child’s hospital stay?
Phoenix Children’s invoices for both facility and professional services in order to comply with Centers for Medicare and Medicaid Services and insurance industry rules. As a result, you may receive multiple bills when you visit Phoenix Children’s or one of our clinic locations. The Phoenix Children’s bill you get is for the use of our facility (facility charges). The charge you get from Phoenix Children’s Medical Group (PCMG) is for the services of Phoenix Children’s physicians, radiologists, and other experts. You may be billed separately from other clinicians’ practices (professional fees). We all work together to ensure that your child receives the best possible care.
What is a facility charge?
The expense of running the facility is covered by a facility charge (hospital or clinic). Supplies, equipment, exam rooms, and non-physician staff are all included. The facility charge is determined by whether your child is a new or returning patient, the type of visit, and the hospital resources required to serve your child properly.
Why is there a facility charge for clinic visits?
Phoenix Children’s Specialty Clinics are licensed as Hospital-based Clinics by the state of Arizona. As a result, they are charged the same facility fee as if they were visiting the main campus. Most other hospital-based clinics across the country follow the same procedure.
Will my insurance cover the facility charge?
This varies depending on the insurance company. Some insurance companies will cover the entire cost, while others will just cover a portion. It’s a good idea to check with your insurance carrier first to see if hospital-based clinic facility expenditures are covered so you know what to expect.
What is a professional fee?
This is your child’s medical bill from the doctor(s) who treated him or her. The bill will come from Phoenix Children’s Medical Group if your doctor works directly for Phoenix Children’s (PCMG). However, we have numerous doctors on our Medical Staff who match our stringent training and experience standards but are not Phoenix Children’s employees. Their professional fees will be billed to you directly by their practice. You may receive bills from many physicians, depending on the severity of your child’s ailment and the treatments offered.
What is an outpatient surgery center and why would I have a procedure done there versus at a hospital?
An outpatient surgery center is a venue where surgeons can deliver services to their patients outside of a hospital’s main campus operating room. The doctor will decide where the surgery will be performed based on the complexity of the procedure and the patient’s medical condition. When a procedure is performed in an outpatient surgery center rather in a hospital operating room, it can be less expensive. The cost would be determined by the procedure’s length, materials utilized, anaesthetic kind and duration, and recovery time, among other factors.
What if my doctor asks another doctor to visit my hospital room while I’m there? Will I be charged for that?
While a patient is in the hospital, primary care providers frequently request that another doctor visit them for a consultation. Parents have the right to refuse a specialty consult or any additional services if a doctor orders them, though we would expect the doctor to explain the rationale or need for the consult or extra service (e.g., therapy, radiology, lab). For this type of supplementary service, you may receive two bills: one from Phoenix Children’s and one from Phoenix Children’s Medical Group (PCMG) or an outside physician practice for the time of the specific physician.
Does Phoenix Childrens Hospital accept Ahcccs?
The Arizona Health Care Cost Containment System (AHCCCS) is requesting clearance to continue the Safety Net Care Pool (SNCP) in Special Term and Condition (STC) 26 with Phoenix Children’s Hospital as the sole participant.
Does Phoenix Children’s Hospital take Ambetter?
For consumers with the Health Net Ambetter plan, all PCH services, including doctors, surgery centers, urgent care centers, and laboratories, will be considered out of network beginning January 1, 2018.