As a freelance writer and content producer, I tell patient stories for Cincinnati Children’s Hospital Medical Center. Now I have a story of my own to tell.
My family is about to lose our health insurance coverage at Children’s because the hospital can’t reach an agreement with the Dayton-based health insurer, CareSource Ohio. We have been purchasing CareSource Marketplace insurance for the past seven years in the Ohio marketplace. Each year, I have chosen CareSource specifically because we have two young children.
This change, which begins August 1, does not affect the Medicaid version of insurance. It only affects those who buy it through Healthcare.gov. With the removal of CareSource, there are no plans left in the marketplace where Cincinnati Children’s is in the 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 get most of the specialty pediatric 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 is almost religious. And it’s true. Everyone I have 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, “all families” are negotiable, and all the world’s messages about patient-centered care just go out the window.
Is it CareSource’s fault? Is it Cincinnati Children’s fault? Is one party being too greedy? Are you taking advantage of someone? There are theories everywhere I go on Facebook. The moms group in my neighborhood is burning with anger. But as an average health care consumer, I have no idea.
I know that Cincinnati Children’s ranks third among children’s hospitals in the country. I know from what you report on your site that your total operating income for the fiscal year ending June 30, 2021 was about $2.75 billion and your expenses were about $2.5 billion, which leaves an income of about $2.2 billion. I know that when I work with other children’s hospitals across the country (I write and produce content for several) many try to compete with Cincinnati Children’s, but can’t match their dollars. Is Cincinnati Children’s a more expensive hospital that requires higher reimbursement rates? Or is CareSource an insurance company hungry for money?
Who knows? None of that is transparent. CareSource Marketplace families only receive talking points, not responses. No one who is a decision maker on 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 some new insurance, ma’am. Well, when you’re self-employed, as I have been for 20 years, your options are limited. I love what I do and I make a good living because I’m good at it. But health insurance has always been the asterisk in all of this. Healthcare.gov was a blessing to our family. My husband is a stay at home mom and works part time. (The reasons are too complicated to list here, but trust me when I say it’s the best choice for our family’s health.)
We have used Cincinnati Children’s services many times over the past decade. My husband and I take ADHD parenting classes there. One of my children saw a therapist at Children’s School. That same child sees a neurologist there to help manage Tourette syndrome and OCD. My other son recently had a fracture fixed at his orthopedic clinic.
Still, my family is one of the lucky ones. The stories I have been reading about other affected families, those who have children with complex issues that require ongoing care, or children who have joined therapists, are devastating.
Also, it’s not like there are any real options for where to go in Southwest Ohio if your child needs specialized 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 seen that as a problem, because when you have the best in your backyard, why would you go anywhere else?
But now there is a door around him. I can look inside and tell amazing patient stories. But if I want to take my own children there, I have to be prepared to pay out of pocket. I doubt Children’s commissioned me to tell that story.
Judi Ketteler (@judiketteler) creates healthcare content and is a columnist for Cincinnati Magazine. She is also the author of “Would I Lie to You? The Incredible Power of Being Honest in a World That Lies.”
