Narrow Networks a Challenge for Patients with Cancer

For many patients with cancer, the Affordable Care Act (ACA) was a sign a relief. The law meant that insurers could no longer deny them coverage for pre-existing conditions, nor could they enforce a lifetime dollar limit on their policies. Jill Biden, PhD, second lady of the United States, even emphasized how the ACA would ensure that nearly 50 million women would have access to free mammograms every 1 or 2 years.

Yet, despite these stipulations, patients with cancer may face new barriers to care as they shop for healthcare plans on the state and federal insurance exchanges. Insurers, who remain vigilant in battling the rising costs of cancer treatment, are opting for narrow networks. These plans limit, and even deny, many patients’ access to the country’s top cancer centers and hospitals. This ultimately could prevent the newly insured from receiving the most innovate treatment procedures and medications.

“This is a marked deterioration of access to the premier cancer centers for people who are signing up for these plans,” said Dan Mendelson, CEO of the market research firm Avalere Health.

An Associated Press survey found that only 4 of 19 National Comprehensive Cancer Network institutions said that consumers would have access to their services through all the insurance companies in the state exchanges. These particular hospitals boast better-than-average survival rates due to their leading clinical research and multidisciplinary approach to patient care.

“Overall, when you look at the ACA, it improves access to cancer care,” said Willie Underwood, MD, MPH, MSci, associate professor of surgical oncology at the Roswell Park Cancer Institute. “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.”

Another report, from the Leukemia & Lymphoma Society (LLS), detailed how insurance exchanges will also limit patients’ access to National Cancer Institute (NCI)-designated cancer centers. It means that patients will likely pay higher out-of-pocket costs.

“Qualified health plans are sporadic, at best, and ineffective in covering NCI transplant and cancer centers. For example, in New York, we looked at major insurers in the exchanges and found that Memorial Sloan-Kettering was not covered by many of them,” said Brian Rosen, JD, senior vice president of public policy at the LLS. “These narrow networks are problematic for our patients."

The Obama administration continues to cite cancer care as a priority, saying it will monitor insurance plans offered on the insurance exchanges throughout next year.

Around the Web

Health Law Concerns for Cancer Centers

[The Washington Post]

Insurance Exchanges Limit Access for Patients With Blood Cancer [Medscape]