Of the 19 that responded, four reported access through all insurers, though some insurers did not include them in certain low-cost plans. But for 13 cancer centers, there were significant coverage gaps. For instance, the Siteman Cancer Center at Barnes-Jewish Hospital in St. Louis is not covered by any of the exchange plans offered by Anthem Blue Cross and Blue Shield, a major insurer in the area.
In Utah, the Huntsman Cancer Institute in Salt Lake City is included by five of six Utah insurers but not by Humana, a major carrier.
First, the article reinforces the message that health plans and the federal and state insurance exchanges need to do a better job of informing consumers which hospitals, physicians and other providers are covered as in-network providers. That was emphasized by one provision in a wide-ranging set of rules and guidances issued by the CMS last week.
The CMS and HHS said the proposed rules and draft standardized notices that issuers would be required to use when renewing or discontinuing plans would help to ensure consumers understand the changes and choices in the individual and group market. The government said the proposed rules would “encourage improved consumer protections regarding essential community providers, network adequacy, access to needed prescription drugs and coverage of care during transitions.”
Second, cancer centers and other specialized centers need to do a better job of demonstrating that they provide equal or better value compared with other, nonspecialized facilities. In the more competitive market associated with the insurance exchanges, providers cannot rest on their laurels.
But there also are questions about how well-equipped consumers are to choose health plans based on both cost and quality. That's highlighted by Anthem's statement to the AP about why it excluded the Siteman Cancer Center. It 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 healthcare," the company said. "Our provider networks reflect this."
Providers are likely to read that and chuckle ruefully, knowing that Americans may be willing to make trade-offs of cost, quality and access—until they are diagnosed with cancer.
Follow Harris Meyer on Twitter: @MHHmeyer