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.



jibber jabber

--> Lets SEE.
1. maybe they charge to much.
2. maybe before ObamaCare there was LESS people that could go there.
3. are they charging MORE than what ObamaCare.
4. are doctors still Greedy over greedly.
5. who says this is the greatest cancer center in the world.


lets call it what it is; a failure. obamacare is a failure..

jibber jabber

ObamaCare is far from failure with 8Million signed up.
the old republican Richard Nekson system was just plain murder.


Re: "old republican Richard Nekson system"

Who the h*ll is "Nekson"?


We were "sold" this monstrosicity in order to cover 25 million uninsured, and then becuase of it millions more were dropped from insurance. So yes, 8 million(media says it's more like 6 million) signups is a huge failure. Everyone pays more for less. That's the gov't way.


One of us wants to use actual facts. I was wrong at the 6 million estimate. It's actualy 5 million.


8 Million? where the hell you get that number? The last numbers released were at around 5 million. But yet they have no idea how many actually paid for it. And also by Obummer extending the indibiduall mandate is an admission of failure.


The government is reporting 5 million sign ups and out of that how many were placed into medicaid paid for by the taxpayers? Also of the 5 million that signed up less the medicaid numbers how many have actually paid a premium and have valid coverage?

J. Carney advised: "We just “don’t have specific data for how many people have paid their premiums". If you do know how many paid you might inform J Carney so that he can inform the press.

I do think from the numbers that I have seen that more persons have lost their insurance than have signed up for Obamacare even if all that signed up were placed into an insurance plan and have paid a premium.

I have also read that of all the Obamacare programs the Cleveland Clinic has only 1 in their network ergo many persons even though very satisfied will not be able to keep their insurance company or doctor.

Darwin's choice

jibber jabber, You're full of chit. there hasn't been 8 million people even read even the sign up pages! Obama has granted so many extensions to date because he likes to? The real number of (strong armed) sign-ups may be half your number. Care to post some proof of your lie?

Darwin's choice

Seems it's just more of the same lie....!

Premiums raising faster because of obamacare...!


jibber jabber

crybaby liar. ah hahahaha

Darwin's choice

And, again, full of chit obama/liar/failure.

Dr. Information

More proof, obamacare is a huge failure and dems want people to die.


You have let the government more into your life.

Now they will decide what hospital, what doctor and what treatment.


The gov't is not the real problem here. Ins. Cos. are. It's all about the money!


Re: "It's all about the money!"

So true.

And when the U.S. FINALLY achieves the TRUE goal of single payer, all medical care will be: FREE, FREE, FREE.

Oh glorious day! Oh Brave New World!


That's not true pooh and you know this. Where is ALL medical care free right now? You pay one way or the other.


Re: "You pay one way or the other."

What do those covered by Medicaid pay?


Re:"The gov't is not the real problem here. Ins. Cos. are. It's all about the money!"

Actually the insurance companies profits are regulated by the government and on 3/14/2014 there was a rule change that now allows the insurance companies to retain an additional 2% profit so if Obama really cared about the average person why is he giving the additional profit to the companies?


How are the profits regulated by the gov.? Where do you get this stuff? The gov't sets the Medicare reimbursement rates and insurance cos. follow. Their choice!


Re: "How are the profits regulated by the gov.?"

You're as ignorant as usual.

The Hero Zone's picture
The Hero Zone

Hey now you aren't allowed to bring up the fact that the ACA guarantees profit for private companies by giving them tax money! You are only allowed to discuss the intention of the law, not it's actual effects, flaws, and repercussions. And don't you dare suggest reforming it! Only the President can do that. (sarcasm of course)


@ Mr. Morgan:

Off-topic -

Watch "The Profit" on CNBC. I think you'll enjoy it.


so sad there is a bunch of lazy DUMB F's about this sh@# law


What kind of healthcare ins. do you have and how is it affected by this law?


Re: "What kind of healthcare ins. do you have,"

What do you care? You're on Medicaid.


Let's see...

1. You can keep your doctor.
2. You can keep your insurance.
3. You'll save money on premiums.
4. Access to healthcare will improve.
5. There are no "death panels."
6. It will cost "only" about a trillion dollars over ten years.

Any MORE big lies? And aren't these ENOUGH?

My latest and current least favorite TRUTH? If you sign up for Obamacare, we won't deport your illegal family members. Just. Freaking. AWESOME.

#ObamacareFAIL. #OBAMAfail!


Re: "illegal family members."

"Vote for me and we'll set you free."

Oh, just wait until the progressive-socialists declare that access to health care is a 'right,' like it was in the Soviet Union.

What's wrong with "free"?

A quote from a recent SR article:

“You want it high enough so it doesn’t encourage overuse of the health center. If it’s free, people will just come every day”

- Randy Runyon


American socialists are WAY smarter and can do it better than those 'stoopid' Russian Bolsheviks.


You must be a Sarah Palin fan. What is a death panel? Wasn't that the lie of the year a bit ago? You don't understand the law. Educate yourself and your buddy pooh!


Re: "What is a death panel?"

STILL as ignorant as usual, must be an Obamabot.

Who decides acceptable medical treatments under a single payer govt. run health care system?

Paul Krugman has talked about needing "death panels."