AmeriHealth Caritas PA and Keystone First Contract Termination: Answering a Family's Questions
Letters to participating families with additional details:
What is happening?
CHOP is currently a participating provider of AmeriHealth Caritas PA and Keystone First. However, those contracts will end July 1, 2024, unless a new agreement is signed before that date. If the contract ends, CHOP hospitals, all CHOP physicians and CHOP Home Care will no longer be in network effective July 1, 2024.
If this change does happen, you have options. To continue care with CHOP providers you will need to change health plans. If you prefer to remain with AmeriHealth Caritas PA or Keystone First, you may need to change healthcare providers. We encourage you to choose providers and a health plan that best meets the needs of your family. If you prefer a plan in which CHOP participates, CHOP participates in the following HealthChoices health plans in Pennsylvania.
- Health Partners Plans
- UPMC for You
- Geisinger Health Plan Family
- United HealthCare Community Plan of Pennsylvania (UHCCP PA)
- Highmark Wholecare (families outside the five Philadelphia counties)
We understand that this change adds stress at a time when the most important thing to you is meeting the healthcare needs of your child. Like you, we believe the children of Pennsylvania are entitled to the best healthcare available. Whatever you decide, we will work with you to help make the transition as easy as possible.
Continue reading below for answers to frequently asked questions.
My child is scheduled for services at CHOP in June 2024. What should I do?
Nothing at this time. Your child will be able to access CHOP services prior to July 1, 2024.
My child is scheduled for surgery in June. Will my child be able to receive follow-up care for that surgery?
Your child will be able to receive the standard postoperative care and treatment related to the surgery. Any additional unrelated services will need authorizations from AmeriHealth Caritas PA or Keystone First.
My child is scheduled to see their CHOP specialist on or after July 1, 2024. What can I do?
If the appointment is for continuing care that began before July 1, 2024, AmeriHealth Caritas PA and Keystone First are required to authorize that care, and CHOP will get the authorization for you as we normally would. If we run into difficulty, we will let you know and ask you to please call AmeriHealth Caritas PA Member Services at 1-888-991-7200 or Keystone First Member Services at 1-800-521-6860 and let them know the care began before July 1, 2024).
If this is a new appointment with a specialist you have not yet seen at CHOP, please call AmeriHealth Caritas PA Member Services or Keystone First Member Services and request authorization to continue treatment with your CHOP physician.
Your CHOP specialist may be able to assist you with getting this authorization for follow-up appointments scheduled after July 1, 2024.
If my child’s care is no longer covered by AmeriHealth Caritas PA/Keystone First after June 30, 2024, what are my out-of-pocket costs?
Without coverage for CHOP services by AmeriHealth Caritas PA or Keystone First, your out-of-pocket costs will depend on your specific situation. We can review those with you beforehand.
Can we still see our CHOP primary care doctor?
You may see your CHOP Care Network primary care doctor prior to July 1, 2024. Beginning July 1, 2024, you will need to select a new primary care doctor. If your child has an illness which is being treated on an ongoing basis by your primary care doctor, you will be able to continue with your primary care doctor for about sixty days. Please call AmeriHealth Caritas PA Member Services at 1-888-991-7200 or Keystone First Member Services at 1-800-521-6860 for more information.
I am a pregnant mom who has been under the care of CHOP’s Center for Fetal Diagnosis and Treatment prior to July 1, 2024. How is my insurance coverage affected for me and my baby?
AmeriHealth Caritas PA and Keystone First are required to cover your obstetrical care at CHOP, and CHOP will provide this care through your pregnancy and through completion of postpartum care if you were in your second or third trimester of pregnancy when you received notice from AmeriHealth Caritas PA or Keystone First of the contract termination with CHOP. Your baby will be covered by AmeriHealth Caritas PA or Keystone First through your baby’s discharge from CHOP. You will need to request continued coverage from AmeriHealth Caritas PA or Keystone First for office appointments scheduled on or after July 1, 2024.
My child has a follow-up appointment scheduled in June with a CHOP specialist (for example, a cardiologist). Can my child still see the doctor?
Yes.
My child is scheduled for a first visit with a CHOP surgeon (for example, an orthopaedic surgeon) in July. Can we keep this appointment?
For new patients to CHOP on or after July 1, 2024: An authorization from AmeriHealth Caritas PA or Keystone First is required before we can confirm your appointment or any follow-up care by CHOP.
If you obtain authorization for the appointment prior to July 1, 2024, the appointment will be covered by AmeriHealth Caritas PA or Keystone First. However, you will need to obtain authorization from AmeriHealth Caritas PA or Keystone First for any follow-up care you would like to receive at CHOP. Please make sure to call AmeriHealth Caritas PA or Keystone First to request.
Is CHOP in-network with other Medicaid-managed care plans in Pennsylvania?
Yes. CHOP is an in-network provider under the following PA HealthChoices health plans:
- Health Partners Plans
- UPMC for You
- Geisinger Health Plan Family
- United HealthCare Community Plan of Pennsylvania (UHCCP PA)
- Highmark Wholecare (families outside the Philadelphia 5 counties)
Below are the ways you can contact PA Enrollment Services to choose a new health plan:
- Visit ENROLLNOW.NET - or -
- Call PA Enrollment Services at 1-800-440-3989 (TTY: 1-800-618-4225) to speak with a representative. You can call Monday through Friday, 8 a.m. to 6 p.m.
As a patient, what are my rights?
For information about your rights as a member, please call AmeriHealth Caritas PA Member Services at 1-888-991-7200 or Keystone First Member Services at 1-800-521-6860, or the Pennsylvania Department of Human Services at 1-800-692-7462.
My child has Pennsylvania Medical Assistance, not through a Medicaid plan. How will this impact my child's coverage?
This will not impact any children enrolled in Pennsylvania Medical Assistance. CHOP and our physicians will remain enrolled with PA Medical Assistance.
We have a commercial plan as our family’s health insurance company. Does this impact my child’s ability to access CHOP?
No, none of the commercial plans are impacted by the termination of the AmeriHealth Caritas PA or Keystone First contracts. However, if you have AmeriHealth Caritas PA or Keystone First as secondary, your secondary coverage will be impacted.
If AmeriHealth Caritas PA or Keystone First does not authorize my child’s care on or after July 1, 2024, at CHOP, may I pay out of pocket for my child’s care?
If AmeriHealth Caritas PA or Keystone First does not allow your child to continue care at CHOP, we suggest that you ask them for an in-network provider.
If you still want to receive care at CHOP after July 1, 2024, and AmeriHealth Caritas PA or Keystone First has denied your child continued coverage, your out-of-network costs would be higher than those of an in-network provider. We will not bill you without your acknowledgement first.
My child is scheduled for Behavioral Health Services at CHOP. Can we continue to come to CHOP?
Your Behavioral Health Managed Care Plan will not change. Call your Behavioral Health Managed Care Plan if you have questions about behavioral health coverage.
My child receives services from CHOP Home Care. Can we continue to receive home care services from CHOP?
Keystone First patients currently under the care of CHOP Home Care will be able to continue to receive services from CHOP Home Care through June 30, 2024. Beginning July 1, 2024, if you choose to remain with Keystone First, then you will need to select a new Home Care provider. Please call Keystone First at 1-800-521-6860 to find out about your options.