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

deertracker

How is he right?

Contango

Re: "How is he right?"

Answer the question:

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

Do you enjoy your Medicaid (socialism)?

The Big Dog's back

What production and the means for production are CONTROLLED by Gov?

Contango

Sheesh! Not what I wrote. Read it AGAIN, piddles.

pntbutterandjelly

And who and how are your roads being paid for Contango? Or...do you want corporations to do everything for you? You know...the guys running the country with their lobbyists.

Contango

Re: "roads,"

Early American road, canal and water way building were privately financed and maintained.

Today, roadways are a Gordian Knot of collectivism.

----------------------

Re: "the guys running the country with their lobbyists."

Too ideologically simplistic.

Taxpayer subsidized not for profits (AARP, et. al) have their lobbyists too.

Better take a look at whom gives what to whom:

https://www.opensecrets.org/orgs...

anthras

Re:" And who and how are your roads being paid for"

I think the roads are paid for by the people of this country. The government will give us anything we want using our money.

kURTje

Who stopped oldsters from going to Canada to obtain lower cost maintenance medicine? (Mean while waves of Canadians are coming to America for health care.

Dr. Information

The truth about who dems area is starting to really show up. They still want to stand behind this polished turd and watch people denied treatment or have to go all over the world for treatment, just so they can try and save party face. Sad

wally44824

oBUMacare is an even bigger joke than the "work" done by Barry over the last 6 years. Less than 700 days until he's out of office...let the countdown begin. WORST President EVER!!!!

hilltop

If you die before you can collect all your Social Security, where does the rest go . . . . the government.

If you die before you can get treatment, who prospers . . . . the insurance company.

If you get "bargain basement" medical care and you die, then the government and the insurance company benefit.

You all just need to fully understand that the maggots who run this country only care about the 1% of the people that keep them in power. The same 1% that keep feeding us all candidates that change nothing, do nothing and care about nothing but themselves.

Contango

Re: "If you die before you can get treatment, who prospers . . . . the insurance company."

Fallacy.

And if the insured lives, the ins. co. collects future premiums and makes more money.

The 1% (nomenklatura) generally live in Washington.

Who lives in Washington: Bureaucrats, politicians and lobbyists - The Iron Triangle.

http://www.washingtonpost.com/sf...

kURTje

Hilltop you are right. Give US the same health Nancy Reagan & Nancy Pelosi get...that is fair.

Contango

Re: "Give US the same health Nancy Reagan & Nancy Pelosi get,"

"Give"?

Who's paying for it?

kURTje

That is exactly my point. Those old krones get health from the taxpayers. They should get the same as US.

Contango

Re: "They should get the same as US."

Re: "Give US the same health (sic) Nancy Reagan & Nancy Pelosi get,"

No "point." Conflicting statements.

Which is it?

starryeyes83

Not to worry, in another year or two the premiums will be so astronomically high, no one will be able to afford any kind of health care.

We're pretty much all Effed.

Jack518

Insurance companies have sold most of the public and government officials blaming doctors.

Isurance companies like to blame doctors, hospitals, pharmacies and lawyers for the high cost of healthcare. Do yourself a favor, drive the outerbelt around Columbus, Ohio on the west side of town. You will see a large number of insurance corporate headquarters. They are large, modern buildings with acres of manicured estates, ponds with fountains and some have either cottages or golf courses.

Insurance agents get paid monthly based on the amount the accounts, recieve bonuses, special weekend vacations, etc. The higher the rise in the company, the more they make. Remember, these are NOT doctors, but salesmen.

Some may point to doctors charges as being too high. The next time you visit a specialist, ask him or her how many years they spent in college, working as interns, residents and more time in their specialty. Then ask them how old they were before they began making a living and how long they will practice before retiring.

One last thing, ask them what pertcentage of the practice's income goes for medical insurance.

Contango

Re: "medical insurance"

You forgot the lawyers.

If a doc isn't being sued, he's not practicing.

anthras

Re: "Insurance agents get paid monthly based on the amount the accounts, recieve bonuses, special weekend vacations, etc. The higher the rise in the company, the more they make. Remember, these are NOT doctors, but salesmen."

I do think that insurance companies cannot just charge what ever they wish to charge I think they must file any request for premium increases with the state department of insurance. If the premium increase is justified they will most likely be granted approval however if the premium increase would indicate an excessive profit the increase would be denied.

Maybe what you should do is direct your complaint to the Ohio Department of Insurance.

grumpy

And now just think... the administration of obama, and the democrat "party" has made it a law that everyone has to buy insurance, from insurance companies... and also the gov't guarantees insurance companies to make a profit. ObamaScare, and the democrats are the best thing that has ever happened for healthcare insurance companies... guaranteed profit... guaranteed customers. You will now be fined if you don't buy health insurance from insurance companies and the gov't guarantees insurance companies profit... no matter what. That sure showed insurance companies.

Contango

Pres. Obama 'quietly' killed the individual mandate.

Can't afford the high Obamacare premium? No penalty!

http://www.upi.com/Top_News/US/2...

The Hero Zone's picture
The Hero Zone

Oh yeah, this has been murmured about yet oddly never seemingly headlined. You think it would, especially on a cheerleader such as the Huffington Post. Yet oddly enough I never saw oversized, colored font that read "By the Grace of President, Pen Exempts Individuals from Mandatory Coverage" with the subheading "just provide some kind of documentation or something...if you can".

This truly is a centerpiece law. One that reaches out to everyone yet ultimately touches nobody. It's a bragging point alone. A gruesome trophy for those who passed it. Ultimately? Wasteful and destructive. The tragedy is that it is all meaningless.

"The different cardinal truths neither clash nor mesh. No one is invalidated, but nobody is right."

Contango

Re: "just provide some kind of documentation or something...if you can".

Some analysts have equated it to the income statements for the "liar loans" which led to the subprime housing crisis.

Yea, I couldn't afford it - trust me.

Wait until the underfunded insurers tap the $20B taxpayer slush fund in response to the poor number and quality of the sign-ups.

Should make for some interesting headlines and conversation.

The Hero Zone's picture
The Hero Zone

They'll be interesting because it will be "their fault" if it happens. The faultless government whose intentions are (as one of my favorite lines from The Shawshank Redemption) cleaner than a virgin's honeypot and never meant for any of this to happen will happily vilify then swoop in to simultaneously condemn and save them through some kind of next-step nationalization. It's ridiculous and makes me angry that I am getting angry, which in turn makes me appreciate the fact I have hobbies as outlets for that frustration.

Is the slush fund you talk about the one that was tapped into early on as an "experiment" to keep cuts to other programs from being felt until after the last election? I remember something about that. Meanwhile our schools don't have any kind of mandatory education about economics so stories like this will persist among those who can't/won't see the "man behind the curtain".

Contango

Re: "experiment,"

Don't have an answer; however:

http://nypost.com/2014/03/21/oba...

Economics is SO boring! Better to just 'trust' those in the know. :)

H*ll, according to the Fed's own minutes, even with the best economic models and tools in the world, they were clueless as to the extent of the damage at the end of '08.

http://www.nytimes.com/2014/02/2...

pntbutterandjelly

I am self-employed. I have worked physically and mentally hard for all I have and own. I am a registered Independent voter. I self-pay for my insurance. The Affordable Care Act now saves me 35% on my premiums, lowered my deductible by 50%, I have much better coverage and...my grand total out of pocket expenses for any period have been dramatically lowered as well. {AFFORDABLE Care Act.} Try it. You might like it.

grumpy

Any single example of it helping someone is offset by an example of someone with the opposite experience. You won the obamaScare lottery, not everyone has. Congratulations.

The Hero Zone's picture
The Hero Zone

Said neutrally:

I appreciate your anecdote has worked for you. I don't doubt that there are people like you that exist, a point even Grumpy illustrated. I could then presume that with the pride you post about your policy that you are not receiving subsidies for your coverage?

If you can, generically if you don't want to give away identifying info, can you please post your "Before" and "After" policies? That will do much to better and further convey your point. If you can overcome the naysayers/skeptics, with me being one of them, then you will find yourself surrounded by allies.

Contango

Re: "The Affordable Care Act now saves me 35% on my premiums,"

Due to your age and the insurers' expectation and projections that the young Invicibles would actuarially help offset your heavily subsidized premium.

Why do you think Pres. Obama is out there selling the youth on signing up like some kind of late night product hawker?

Way too early to tell on whether your premiums and coverage will be remain stable.

At present, the pool is too small and consists heavily of older insureds and those with pre-ex.

I've heard rumblings (CNBC) that some insurers expect to raise premiums by 50% or more for 2015.

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