Report Urges Better Network Adequacy for Cancer Patients

For the 1.3 million Americans living with blood cancers, their already daunting condition is not made any easier by the fact that private health plans — particularly those on the Affordable Care Act exchanges — often exclude National Cancer Institute (NCI)-designated treatment facilities from their provider networks, according to a new analysis.

The report, produced by Manatt Health and The Leukemia & Lymphoma Society, focused on four states’ policy and regulatory frameworks governing marketplace plans, with researchers conducting interviews with state regulators, insurers and cancer care providers to learn about “policy challenges that may hamper patients’ ability to navigate and obtain proper treatment for their cancer.”

It found that there is significant variation in how states regulate plan network development, network maintenance, appeals and grievance rights and processes, and other cancer care-related consumer protections. The appeals-and-grievance process is the primary tool that allows patients to seek medically necessary out-of-network care, but that process is often very difficult to navigate, the report argued. In fact, payers and state regulators reported that patients “often do not appeal plan decisions, due partly to complex appeals and grievances process or simply a lack of awareness.”

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Leslie Small

Leslie Small

Leslie has been working in journalism since 2009 and reporting on the health care industry since 2014. She has covered the many ups and downs of the Affordable Care Act exchanges, the failed health insurer mega-mergers, and hundreds of other storylines spanning subjects such as Medicaid managed care, Medicare Advantage, employer-sponsored insurance, and prescription drug coverage. As the managing editor of Health Plan Weekly and Radar on Drug Benefits, she writes and edits for both publications while overseeing a small team of reporters who also focus on the managed care sector. Before joining AIS Health, she was a senior editor for the e-newsletter Fierce Health Payer, and she started her career as a copy editor at multiple local newspapers. She graduated with a dual degree in journalism and political science from Penn State University.

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