Cincinnati Children’s no longer takes my insurance
As a freelance writer and content producer, I tell patient stories for Cincinnati Children’s Hospital Medical Center. Now I’ve got a story of my own to tell.
My family is about to lose our health insurance coverage at Children’s because the hospital cannot strike a deal with Dayton-based health insurer CareSource Ohio. We’ve been buying CareSource Marketplace insurance for the past seven years from the Ohio marketplace. Each year, I have chosen CareSource specifically because we have two young children.
This change, which begins August 1, doesn’t affect the Medicaid version of the insurance. It only affects those who buy it via Healthcare.gov. With CareSource pulling out, there are no remaining marketplace plans where Cincinnati Children’s is in network.
So now, about 1,000 families like mine are effectively cut off from care at Cincinnati Children’s – which, to be clear, is the ONLY place to go for most pediatric specialty care in the area.
Do you know how many videos I’ve produced where the main message is the patient-centered care available at Children’s? The way families and providers talk. It’s religious almost. And it’s true. Every person I’ve met associated with Children’s has been exemplary. My own experiences there with my children have been exceptional.
In fact, the first thing you see on their home page is, “We’re here for every family, every child, every future.”
But apparently, when money is on the table, “every family” is negotiable, and all the messaging in the world about patient-centered care just goes out the window.
Is it CareSource’s fault? Is it Cincinnati Children’s fault? Is one party being overly greedy? Is someone being taken advantage of? There are theories in all the places I frequent on Facebook. My neighborhood moms’ group is on fire with anger. But as an average consumer of health care, I have absolutely no idea.
I know that Cincinnati Children’s is ranked #3 among pediatric hospitals in the nation. I know that, according to what they report on their site, their total operating revenues for the fiscal year ending June 30, 2021 were about $2.75 billion and their expenses were about $2.5 billion, leaving a revenue of about $2.2 billion. I know that when I work with other children’s hospitals in the country (I write and produce content for several) many are trying to compete with Cincinnati Children’s, but can’t match their dollars. Is Cincinnati Children’s a more expensive hospital, demanding higher reimbursement rates? Or is CareSource a money-hungry insurance company?
Who knows? None of it is transparent. CareSource Marketplace families are only getting talking points, not answers. Nobody who is a decision-maker in the matter seems to care about us. We’re expendable and it’s just the cost of doing business.
You might be thinking, just get new insurance, lady. Well, when you are self-employed – as I have been for 20 years – your options are limited. I love what I do and make a nice living because I’m good at it. But health insurance has always been the asterisk in all of it. Healthcare.gov was a godsend for our family. My husband is a stay-at-home-dad and works part-time. (The reasons are too complicated to enumerate here, but trust me when I say it’s the best choice for our family’s health.)
We’ve used Cincinnati Children’s services many times in the last decade. My husband and I took ADHD parenting classes there. One of my children saw a Children’s school-based therapist. That same child sees a neurologist there to help manage Tourette’s and OCD. My other child recently had a fracture fixed at their orthopedic clinic.
Still, my family is one of the lucky ones. The stories I’ve been reading about other families affected – those who have children with complex issues requiring ongoing care, or children who have bonded with therapists – are devastating.
Plus, it’s not like there are actual choices about where to go in Southwest Ohio if your child needs any specialty care. Adult hospitals don’t want to touch pediatric cases. Pediatricians refer directly to Children’s. The hospital effectively has a monopoly. I’ve never looked at that as a problem, because when you have the best in your backyard, why would you need to go anywhere else?
But now there is a gate around it. I can look in and tell amazing patient stories. But if I want to take my own children there, I need to be prepared to pay out of pocket. I doubt Children’s will commission me to tell that story.
Judi Ketteler (@judiketteler) creates health care content and is a columnist for Cincinnati Magazine. She’s also the author of “Would I Lie to You? The Amazing Power of Being Honest in a World That Lies.”