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Cancer patients can get coverage under health care law, but some of best hospitals off-limits

Administration: Networks will get closer scrutiny next year

By Ricardo Alonso-Zaldivar

Associated Press

Published: Wednesday, March 19 2014 7:53 a.m. MDT

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, Tenn. One caveat: Some insurers did not include these cancer centers on certain low-cost plans.

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

For the remaining 13, the gaps are 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," Underwood said. "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," Zenger said.

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.

The Associated Press asked 23 institutions that are part of the National Comprehensive Cancer Network whether they were included in the networks of insurance companies operating on their state's exchange. Here are the responses they provided:

Fred & Pamela Buffett Cancer Center, Omaha, Neb.: In-network with three of four exchange insurers, but one of them includes Buffett only on some plans. A fourth insurer does not include Buffett.

City of Hope, Los Angeles: In-network for one of three major insurers; a fourth is a health maintenance organization with its own hospital system.

Dana-Farber, Boston: No response.

Duke Cancer Institute, Durham, N.C.: In-network with the two insurers on the exchange, although not included in a low-price option.

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