The issue driving the exclusions is price. Insurers “are feeling pressure to compete on price in ways they have not felt quite so much before,” Blumenthal noted. When it comes to cancer care, prestigious centers like M.D. Anderson Cancer Center in Houston and Memorial Sloan-Kettering Cancer Center in New York City often charge significantly higher prices than local hospitals or community oncology practices, even when they deliver the same care.
The issue is likely to play out over the coming months as people who purchased the narrow network plans seek cancer care for the first time. Even many community oncologists included in local networks say the restrictions may limit their options.
Dr. Barry Brooks, a Texas oncologist and a spokesman for the US Oncology Network, a group representing more than 1,000 community-based oncology practices in more than 15 states, said access to cancer centers is critical for many patients. “We routinely refer patients who are in desperate circumstances, where therapies have been exhausted, or with rare diseases, where there are no standard therapies,” he said. “I don't think the insurers are looking very much beyond the price tag.”
Still, Brooks said, cancer patients don't have to go to a major academic institution to receive good cancer care in the vast majority of cases. He contends cancer patients can usually get high quality care from local providers, who are equally as good.
Insurance company policies differ on their approaches to approving treatment at leading cancer centers when patients have exhausted local options or prefer treatment at a more prestigious cancer center. Cigna Corp. said that in the five states in which it offers exchange plans, the leading cancer centers are included in its networks.
Humana said its health plans, including those sold through the insurance exchanges, offer access to specialized cancer centers in certain locations, but not all. They note, for example, that the Fred & Pamela Buffett Cancer Center is included in Omaha; the Duke Cancer Institute is available to policyholders in Durham, N.C.; and the UCSF Helen Diller Family Comprehensive Cancer Center is covered in San Francisco.