Children’s Hospital Oakland Is No Longer Part of the United Healthcare/PacifiCare Network
Answers to your questions about United Healthcare/PacifiCare >
United HealthCare/PacifiCare Network Update
10/08/09
• Talks between Children's and United are scheduled to resume in October. While there are significant issues to address, we are hopeful that this dispute may be resolved and a new contract signed. Please feel free to check back with us for updates as new information becomes available.
06/01/09
• The agreement between Children's Hospital and United HealthCare/ PacifiCare has ended. In spite of efforts by both parties, a new agreement could not be reached.
• This situation does not affect patient access to physician services. Patients may continue to see their doctors with no charge or interruption. .
• The change in access to Children’s Hospital depends on the type of insurance plan you have
• The best way to know how this may affect your access is to call 510-428-3626, and we can help. If you have questions, you can leave a message for us to call you.
- Now that Children’s Hospital is out of the United network, what does this mean for patients with United insurance?
- Why can my child receive some outpatient services and not others at Children's?
- My son has diabetes and is seen by a physician at Children's. Can he still see that physician?
- I have dependent children. If they need to be hospitalized for something other than an emergency, do I still have coverage for in-patient services under the Pacificare plan?
- If my child needs emergency treatment, can I still bring him to Children's?
- My child had an acute onset of a condition that required a hospitalization prior to the termination. Now my child needs additional follow-up care as a result of that condition. Can my child receive it at Children's?
- My child is chronically ill and receives continued care at Children's Hospital? Will my child's care at Children's Hospital still be covered by United now that the contract has ended?
- Does this contract include access to Children’s Hospital physicians?
- Is there still a possibility that you will sign a new contract with United and become an in-network provider again?
- When did the current contract end?
- Does this termination impact patients covered under Medi-Cal?
- Who do I call if I have questions about my benefit coverage?
- What is special about children's hospitals?
Now that Children’s Hospital is out of the United network, what does this mean for patients with United insurance?
The potential change will depend on the type of health plan you have.
People with HMO coverage will have access to Children’s Hospital only through the emergency room.
People with PPO coverage may have out-of-network benefits that still allow them to access care at the hospital.
The best way for you to know how this may affect your access is to call 510-428-3626, and we can help.
This does not affect patient access to physician services. Patients may continue to see their physicians with no change or interruption. It also does not impact access to emergency care – people may continue to access emergency room services at Children’s Hospital.
Why can my child receive some outpatient services and not others at Children's?
We know this may be confusing. Some outpatient services are paid for by the patient's assigned IPA/Medical Group and some outpatient services are paid by PacifiCare. Our contract and the physicians' with the IPA/Medical Groups are still valid and are being honored. This is what allows patients to continue to come for clinic visits and other routine ancillary outpatient services. Some services are PacifiCare's financial responsibility and unless they have approved the patient for continuity of care, they may not authorize these services due to our non-contract status. If you have questions regarding these services, please contact Member Services at 800.624.8822.
My son has diabetes and is seen by a physician at Children's. Can he still see that physician?
Yes, you can continue to bring your son to see his treating physician at Children's. The contract between the Children's specialists and your child's primary care physician/medical group remains intact.
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I have dependent children. If they need to be hospitalized for something other than an emergency, do I still have coverage for in-patient services under the Pacificare plan?
Yes, your coverage is unaffected, however, your child would most likely be referred to Lucille Packard or UCSF for inpatient hospitalization that is non-emergent.
If my child needs emergency treatment, can I still bring him to Children's?
Yes, emergency care treatment is still covered under your Pacificare plan and can be provided at the nearest hospital whether it is contracted or not.
My child had an acute onset of a condition that required a hospitalization prior to the termination. Now my child needs additional follow-up care as a result of that condition. Can my child receive it at Children's?
Within the PacifiCare agreement is a provision for "continuity of care" when a provider becomes non-contracted. If your child was under the care of a provider when the contract terminated your child may be eligible to continue to receive services from that provider until the course of care is completed. There are some specific types of situations that are covered under this continuity of care provision. Detailed information, including a Request for Continuity of Care Benefits form, are available on the PacifiCare website (www.phs.com). We also have copies of the Continuity of Care document and form available through HR.
My child is chronically ill and receives continued care at Children’s Hospital? Will my child’s care at Children’s Hospital still be covered by United now that the contract has ended?
Under certain circumstances, United will continue to cover your child’s care after a contract has ended; this is called continuity of care. The best way to know if your services qualify for continuity of care is to call us at 510-428-3626, and we can help.
Does this contract include access to Children’s Hospital physicians?
No. These contract negotiations do not include Children’s Hospital physicians.
Is there still a possibility that you will sign a new contract with United and become an in-network provider again?
We are hopeful that we will reach an agreement with United. As of October, 2009 talks are scheduled to resume between the parties.
When did the current contract end?
The contract ended May 31, 2009. As of June 1, Children’s Hospital Oakland is no longer in the United network.
Does this termination impact patients covered under Medi-Cal?
No. Access to Children’s Hospital for patients covered under the Medi-Cal plan is not affected by these negotiations.
Who do I call if I have questions about my benefit coverage?
If you have questions regarding your specific benefit coverage, please call us at 510-428-3626, and let Children’s Hospital help you. You can also email us at unitedquestions@mail.cho.org or submit your questions to us online.
What is special about children's hospitals?
California’s children’s hospitals are the regional, tertiary-care centers that treat children with the most serious and life threatening diseases like childhood leukemia, cancer, heart defects, sickle cell anemia, diabetes and cystic fibrosis. California's children’s hospitals treat more than one million children’s injuries and illnesses each year without regard to a family’s income or ability to pay and are the pediatric health care safety net for the majority of the state’s low-income children.
Children’s hospitals are also the training centers for pediatric sub-specialists and other pediatric healthcare professionals and they are the nation’s premier pediatric research centers making children’s hospitals the source of scientific discoveries in biomedical research that benefit all children. For example, the polio vaccine was first tested in a children’s hospital and pediatric AIDS was first diagnosed at a children’s hospital.
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