CINCINNATI — A contract disagreement between Cincinnati Children’s Hospital and an insurance corporation called CareSource will leave at least 1,000 children without affordable access to their treatment.
WCPO 9 News was alerted to the change last month when parents reached out for help.
Parents received a letter in the mail from the hospital informing them that it could not strike a deal on a contract with CareSource. So, the hospital said CareSource will be canceling its in-network coverage for those families starting August 1, 2022. The insurance policies the families have now are HMO policies. That means they do not have out-of-network coverage and would have to pay for any treatment they received out of their own pockets.
This impacts those who purchase their coverage from the Ohio Marketplace. It does not impact Medicaid patients or patients who get their insurance through a parent’s employer.
Now, more parents have contacted us for help after receiving a letter in the mail from CareSource.
This letter promises to extend a child’s coverage if the hospital pre-authorizes it.
Nikki Hoff is a Cleveland mother who is waiting for pre-authorization on her child’s brain surgery next month.
“She’s having deep brain stimulation surgery, and it’s actually two surgeries,” said Hoff. “Then, I will have to go each month for a year to have the machine calibrated.”
That means her daughter will need insurance coverage past the 90-day extension.
However, Cincinnati Children’s Hospital does not consider any options on the Ohio Marketplace in-network now. The marketplace was formed for those who do not qualify for Medicaid and do not get insurance through a group program that an employer would provide, for example.
“I don’t know where to go,” said Hoff.
The letter from CareSource lists other hospital options, which includes Dayton Children’s Hospital. CareSource is also based in Dayton.
“It's going to add up pretty quickly,” said Matt Bladin. “We're just hard-working people that want to have a family.”
Bladin helped WCPO 9 News shine a light on the problem last month.
U.S. Rep. Brad Wenstrup covers his district.
Rep. Wenstrup told WCPO 9 News “When patients no longer have coverage to a trusted, reliable care provider, it is of grave concern to all involved.”
He said he is discussing the problem with other lawmakers.
Ohio’s Governor Mike DeWine’s administration is aware of the problem. They deferred comment to the Department of Insurance, which regulates coverage sold in the state.
In a statement, the department said it’s aware of the issue, and encourages consumers to file a complaint so it can review each situation on a case-by-case basis.
The hospital and CareSource will not say why they failed to agree on the contract.
CareSource wrote in a statement:
“Our members rely on CareSource Marketplace plans for affordable health insurance. In order to maintain that affordability, we work together with providers. We value our relationship with Cincinnati Children’s Hospital Medical Center and while we were hopeful we could come to terms, we were not able to reach a Marketplace agreement. This change only affects Marketplace members and does not change our Medicaid product.
CareSource is currently contracted with other children’s hospitals across the state. We are working to ensure children with critical access needs receive the continuity of care they deserve.”
A statement from Cincinnati Children’s Hospital reads:
“Families affected by the insurance company’s decision have been informed that if the care received at Cincinnati Children’s is for a diagnosis that is serious and complex, they may qualify for 90 days of continuing care by the insurer. Those families may request that the insurance company continue to cover care at Cincinnati Children’s as 'in network.'"
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