New health care plans limit access to top cancer centers

MD Anderson Cancer Center included in less than half of plans in Houston area; Memorial Sloan-Kettering included by two out of nine plans in New York
Associated Press
Mar 19, 2014

Some of America's best cancer hospitals are off-limits to many of the people now signing up for coverage under the nation's new health care program.

Doctors and administrators say they're concerned. So are some state insurance regulators.

An Associated Press survey found examples coast to coast. Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington's insurance exchange. MD Anderson Cancer Center says it's in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more.

In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP's survey said patients have access through all the insurance companies in their states' exchanges.

Not too long ago insurance companies would have been vying to offer access to renowned cancer centers, said Dan Mendelson, CEO of the market research firm Avalere Health. Now the focus is on costs.

"This is a marked deterioration of access to the premier cancer centers for people who are signing up for these plans," Mendelson said.

Those patients may not be able get the most advanced treatment, including clinical trials of new medications.

And there's another problem: it's not easy for consumers shopping online in the new insurance markets to tell if top-level institutions are included in a plan. That takes additional digging by the people applying.

"The challenges of this are going to become evident ... as cancer cases start to arrive," said Norman Hubbard, executive vice president of Seattle Cancer Care Alliance.

Before President Barack Obama's health care law, a cancer diagnosis could make you uninsurable. Now, insurers can't turn away people with health problems or charge them more. Lifetime dollar limits on policies, once a financial trap-door for cancer patients, are also banned.

The new obstacles are more subtle.

To keep premiums low, insurers have designed narrow networks of hospitals and doctors. The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans.

By not including a top cancer center an insurer can cut costs. It may also shield itself from risk, delivering an implicit message to cancer survivors or people with a strong family history of the disease that they should look elsewhere.

For now, the issue seems to be limited to the new insurance exchanges. But it could become a concern for Americans with job-based coverage, too, if employers turn to narrow networks.

The AP surveyed 23 institutions around the country that are part of the National Comprehensive Cancer Network. Two additional institutions that joined this week were not included in the survey.

Cancer network members are leading hospitals that combine the latest clinical research and knowledge with a multidisciplinary approach to patient care. They say that patients in their care have better-than-average survival rates. The unique role of cancer centers is recognized under Medicare. Several are exempt from its hospital payment system, instituted to control costs.

AP asked the centers how many insurance companies in their state's exchange included them as a network provider.

Of the 19 that responded, four reported access through all insurers: the Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore, Fox Chase Cancer Center in Philadelphia, Duke Cancer Institute in Durham, N.C., and Vanderbilt-Ingram Cancer Center in Nashville. One caveat: Some insurers did not include these cancer centers on certain low-cost plans.

Two centers had special circumstances. The best known is St. Jude's Children's Research Hospital in Memphis. Treatment there is free as long as children have a referral.

For the remaining 13, the gaps were evident.

In Buffalo, N.Y., Roswell Park Cancer Institute is included by five of seven insurers in its region. But statewide, the picture is much different: Roswell Park is not included by 11 of 16 insurers. Dr. Willie Underwood, associate professor of surgical oncology at the teaching hospital, says that's a problem.

"Overall, when you look at the Affordable Care Act, it improves access to cancer care," said Underwood. "When it comes down to the exchanges, there are some concerns that we have. That is not being critical, that is being intelligent. There are some things we should talk about ... before they start becoming a problem."

Melanie Lapidus, vice president for managed care at Barnes-Jewish Hospital in St. Louis, home to Siteman Cancer Center, said she doesn't think patients realize the exchanges offer a more restrictive kind of private insurance.

Lapidus cited Anthem Blue Cross and Blue Shield, which includes Siteman in many of its plans outside the Missouri exchange, but none within the exchange.

"We have had many people say to us, 'I picked Anthem because you guys are always in their products, and I assumed you would be in their exchange products'," Lapidus said. "It's still hard to tell who is in network and who is not."

In a statement, Anthem said its network was based on research involving thousands of consumers and businesses. "What we learned was that people are willing to make trade-offs in order to have access to affordable health care," the company said. "Our provider networks reflect this."

Huntsman Cancer Institute in Salt Lake City is included by five of six Utah insurers, but Mark Zenger, who manages the center's negotiations with insurance companies, said he's concerned about getting left out by Humana, a major carrier.

"We are worried about the potential to have these Humana exchange members seek treatment and have no other option," said Zenger.

Humana spokesman Tom Noland said patients can have access to Huntsman for complex procedures, on a case-by-case basis.

Some state insurance regulators see a problem.

"I want insurers to be able to innovate and come up with new product designs," said Mike Kreidler, insurance commissioner for Washington state. "At the same time, there is a requirement for regulators like myself to be vigilant to make sure there aren't unreasonable compromises."

The Obama administration says it has notified insurers that their networks will get closer scrutiny for next year in the 36 states served by the federal exchange. Cancer care will be a priority, it says.

 

Comments

tk

It isn't just "some former community organizer" lecturing them about responsibility. It is the President Of the United States. Time that you accept the fact that he is the President.

Contango

Re: "he is the President."

Some have observed that that he enjoys the title and position, but not the responsibility that comes with the job.

He is the most inexperienced and incompetent person that ever had the title.

Donegan

To be the President you have to do more than sucker millions of brainless followers to elect you, You actually have to take responsibility for your actions. This guy does neither so he is a "President" in title only im my book. Sorta like the same way he is a noble peace prize winner, Just a useless title.

anthras

Re:" It's just they don't care for the black boogie man in the WH"

I was just wondering if you voted for Strickland or Ken Blackwell for governor of Ohio. If you did not vote for Blackwell then you must be a racist.

deertracker

Blackwell helped W win Ohio and where is he now? Dude got played!

meowmix

Quite right deertracker! Ken Blackwell also had a great big "R" beside his name so of course I didn't vote for him.

Contango

Re: "a great big 'R'"

So you strictly vote the party and not the man and or woman?

Not too bright.

anthras

Re: " Ken Blackwell also had a great big "R" beside his name so of course I didn't vote for him."

I have seen many times in these forms that persons post negative thoughts advising that they do not agree with Obama then we are referred to as a racist. Reminds me of a one way street.

meowmix

Really? Gee Contango, do you think it's maybe because I believe in the policies of the Democratic Party???? Nah, that couldn't possibly be it.

deertracker

Ignore pooh meowmix! He is not worth your time!

The Hero Zone's picture
The Hero Zone

You are allowed to follow one party for your own reasons but please stop implying others who don't are doing so on the basis of race. It's pretty insulting (and doesn't reflect well on your party as you are an outspoken member) to be called a racist for disagreeing with someone or something. For that reason too, calling someone a teatard is also lame and does nothing to convey your point.

The Big Dog's back

So sappy, are you saying that about 30% of Repubs aren't racist toward Obama?

Contango

And there are no racist Democrats? lol. Pathetic lil' piddles.

The Hero Zone's picture
The Hero Zone

How can you be racist towards one person? Is Obama his own race? They're either racist per his race, or they dislike him individually as a person and actually don't care about his pigmentation. If I went with one or the other I'd say more Republicans dislike him more as a person (or more specifically as a political leader) than because of his race.

Though I have to wonder from whence you pulled a 30% figure?

The Big Dog's back

White wingnuts.

The Hero Zone's picture
The Hero Zone

Would anyone with an affiliation to the Democratic Party like to pipe up here and either claim him and take him back to HQ or at least disavow him as one of your own? Or is he actually speaking the truth and is the purest incarnation of the party's attitudes, ideals, and especially outreach to Independents and/or Republicans?

Anyone? Come on now. Hearts, minds, and wallets are at stake here. I'll hang onto him for a while longer while I do whatever it is white people do to pass the time. Or pending that I guess I'll just continue to run a local business that serves young people, minorities, homo/bisexuals, religious and non-religious people, etc. That works too.

The Big Dog's back

You just answered my previous question.

The Hero Zone's picture
The Hero Zone

I'm glad I have brought peace and tranquility to your life, you're welcome. If I can assist you further please don't hesitate to post!

Now meanwhile, is there anyone at all who will come get him? I even polished him up and brought some zen to his life. Honestly you're getting Big Dog in better condition that I did. All his misconceptions have been reaffirmed and I can provide a document certifying he won't need updates for at least a few months.

He really just lives in his own world most of the time. Not very high maintenance. If he shows sign of worry just ease his mind by telling him Republicans are bad people and he settles down quickly. I feel bad that I can't keep him myself, but he needs a special forever home with someone who better understands his needs than I.

Donegan

You do realize voting FOR someone because of their race makes you just as racist as those who voted against him right, Hows it feel to be what you despise?

SamAdams

Don't look at ME when you say that kind of thing! Look in the mirror! I wanted a "black boogie man" in the White House 20 years ago. Where were YOU then? I wanted a "black boogie man" in the White House TWO years ago (just not Obama).

Most people don't give a happy rat's a$$ if a politician is black, white, male, female, or anything else. The morons vote based on party; the informed vote based on candidates. The very few idiots who DO vote based largely on race tend to be Democrats who, in their blind hero worship, are far more racist than some of the worst on the right ever thought of being!

The Big Dog's back

sam, is that why Repubs didn't support Blackwell when he ran for Gov?

grumpy

From the people I spoke to about Blackwell, most thought he was too much of a "party" candidate that thinks "party" first instead of what was best for the people in Ohio. Neither major :party is worth a warm bucket of spit. There is little difference in that each "party over spends and little difference in their poor policies. The little difference is what they over spend on and poor policies blame the "other party" for the overspending and poor policies.... Now piddles will tell us why his "party's over spending and poor policies, is better than the other "party's" overspending and poor policies.

The Big Dog's back

The Repubs I spoke to said they would never vote for a Black man.

grumpy

I can't help that your life partner is a racist. I simply can't believe you would speak to any other repube.

anthras

Re:"So who pays for those that do not pay / will not pay...errrrr. US."

So who pays for all those additional persons now on medicaid and who pays the subsidies that are now given to many persons ?

SamAdams

Unfortunately, the same people who always did: The taxpayer (and those WITH insurance). But if you look at the before and after financial scenarios, it was cheaper under the OLD system than under Obamacare.

I've never said healthcare didn't need reform. It did. My objections are that Obamacare is not only failing to FIX the system's problems, but is making it demonstrably worse. A LOT worse!

Contango

"As deadline looms, flurry of Obamacare rule juggling"

"One major change announced by the government will effectively compel insurers selling plans on the Obamacare exchanges for 2015 to increase the minimum number of so-called essential community providers in the plans' networks.

Such providers serve lower-income and other "medically under-served" populations, and include federally qualified health centers, children's hospitals, HIV and STD clinics, and family planning clinics."

http://www.cnbc.com/id/101500220

IOW: Expand the health care network for the lowest possible cost.

"Lower-income" i.e. Medicaid - free.

There is no economic foundation for these Soviet-style diktats, the Obama admin. is merely making up sh*t as they go along based on political expediency.

abigbear

it amazes me on alll the EXPERTS on health care insurance to know all the ins and OUTS MAYBE THEY SHOULD GET A JOB SELLING IT AND READING THE LAW INSTEAD OFF BEING TALKING HEADS OF THE commie left

deertracker

commie left? Please???

Contango

Re: "commie left?"

How is he wrong?

Don't you believe in the govt. controlling the means and regulating production?

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