AmeriHealth Caritas PA and Keystone First Contract Termination: Answering a Family's Questions

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Letters to participating families with additional details:

What is happening?

CHOP is currently a participating provider of AmeriHealth Caritas PA and Keystone First. However, the AmeriHealth Caritas PA and Keystone First contracts will end July 1, 2024, unless a new agreement is signed before that date. If the contract ends, it will affect CHOP hospitals, all CHOP physicians and CHOP Home Care effective July 1, 2024.

It is important to CHOP that your child receives needed care from a qualified provider of your choice. We encourage you to choose a health plan that best meets the needs of your family, including remaining with your current plan if that is best for you. 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. CHOP will continue to support families in achieving this goal.

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. Any additional services outside of postoperative care 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?

Your child may continue to see their CHOP specialist prior to July 1, 2024. For appointments scheduled on or after July 1, 2024, please call AmeriHealth Caritas PA Member Services at 1-888-991-7200 or Keystone First Member Services at 1-800-521-6860 and request authorization to continue treatment with your CHOP physician (which began before July 1, 2024).

AmeriHealth Caritas PA and Keystone First are required by law to authorize continuation of any ongoing course of treatment for up to 60 days from the date AmeriHealth Caritas PA or Keystone First notifies you of the contract termination. Once you receive notice, you should contact AmeriHealth Caritas PA or Keystone First right away. AmeriHealth Caritas PA and Keystone First are also required to help secure the necessary care providers your child needs.

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 July 1, 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. Upon request, CHOP will provide you with a good-faith estimate. If you would like to continue care without coverage, you will need to complete and sign an Advanced Beneficiary Notice form, which states that you agree to pay out-of-network costs.

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. 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 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 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, your appointment is confirmed.

My child has a follow-up appointment scheduled in July with a CHOP medical specialist (for example, pulmonary). Can my child still see the doctor?

Yes, as an existing CHOP patient, your child may see their doctor with continued coverage from AmeriHealth Caritas PA or Keystone First. If granted prior to July 1, 2024, you may continue your child’s treatment or care.

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. AmeriHealth Caritas PA or Keystone First is not required to provide this authorization. Please 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.

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 the suggested provider does not meet your child’s needs, you may file a patient grievance with AmeriHealth Caritas PA or Keystone First or contact the Pennsylvania Department of Human Services.

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. You would be billed and responsible for payment and asked to sign a form agreeing to this.

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.


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