LDN - Health and Fitness

Narrow health insurance networks more likely to exclude top cancer docs

[July 07, 2017] By Andrew M. Seaman

(Reuters Health) - People who want access to the best cancer treatment centers in the U.S. may want to avoid health insurance plans that only offer a narrow network of providers, suggests a new study.

Compared to health insurance plans with larger provider networks, plans with fewer providers to choose from were more likely to exclude cancer doctors at National Cancer Institute (NCI)-Designated Cancer Centers, researchers found.

"We think there should be more transparency about this when patients are signing up for these plans," said lead author Laura Yasaitis, of the University of Pennsylvania Perelman School of Medicine in Philadelphia.

Health insurance plans that offer a narrow network of providers are usually cheaper than plans with more doctors to choose from, Yasaitis and colleagues write in the Journal of Clinical Oncology.

To be able to offer lower premiums, insurance plans might exclude higher-cost doctors or hospitals. Also, some doctors and hospitals may refuse to accept the reimbursement terms offered by the lower-cost plans, thereby excluding themselves.

It's not clear whether a narrow network affects the quality of care people receive, but the researchers say the limited selection may cut access to high-quality providers like those at NCI-Designated Cancer Centers.

A NCI-Designated Cancer Center earns the distinction through top quality care and research, Yasaitis told Reuters Health. Past research shows patients - especially those with the most complex cancer cases - do better at those centers.

To examine access to doctors at those top cancer centers, the researchers analyzed the plans offered in 2014 on the individual health insurance exchanges created by the Affordable Care Act. They looked at differences between geographic areas with and without at least one of the 69 NCI-Designated Cancer Centers, and they compared plans that did or didn't pay for treatment by doctors at those centers.

Altogether, the researchers identified 23,442 oncologists. About three quarters participated in at least one network offered on the insurance exchanges.

The ratio of cancer doctors to patients was higher in the 51 insurance markets with at least one NCI-Designated Cancer Center, at roughly 14 oncologists per 100,000 people, compared to about 9 per 100,000 people in markets without a top cancer center.

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But whereas in areas without an NCI-designated cancer center, nearly 50 percent of oncologists were available to narrow-network plan members, that was true for only about 39 percent of oncologists in areas that did have the highly-rated hospitals.

When the researchers analyzed the 248 insurance plans in markets with NCI centers, they found 33 didn't include any of those institutions' oncologists.

"The narrow-network-included physicians were less likely to be NCI affiliated," said Yasaitis.

The pattern was similar when the researchers looked at markets with National Comprehensive Cancer Network Cancer Centers, which are known for treating complex and rare malignancies.

"The findings are clear and consistent," said Dr. Justin Bekelman, a study co-author also at the Perelman School of Medicine.

Bekelman told Reuters Health that patients need to be aware of their insurance plan's offerings.

"It looks like most of these centers known for the highest quality care are being cut out of these plans," he said.

Bekelman said insurers can mark which insurance plans include NCI-affiliated oncologists.

Yasaitis also said insurance companies should allow people to ask for an exemption that allows them to seek needed treatments.

"They should be able to pursue it at that center without incurring a whole lot of additional charges," she said.

SOURCE: http://bit.ly/2sRBALw Journal of Clinical Oncology, online July 5, 2017.

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