Obamacare Exchanges and "routine" cancer treatment: A touching story of haves versus “have an Exchange plan”
NOTE!!!! I am using my own Washington State for case studies in my posts because we seem to have fairly stable web sites for looking up information. If you research in your state, I believe you will find largely similar results. The point of this post is that doctors and hospitals in this country are intermingled, as health “care” mega-corporations swallow little guys etc. Because of this, thin provider networks create severely limited patient care, in a far more complicated way than simply requiring us to choose alternate providers. I repeat,this is NOT, NOT, NOT NOT a Washington-state-specific problem.
The heartwarming story/myth
I perused the web site of Evergreen Medical Center, an Exchange-plan friendly hospital in my state. There, I found lovely marketing materials, success stories of breast, colon, blood and other cancer cures. I could almost hear the violins playing.
For a second, my cynical heart melted. Maybe I’m being a little too shrill about this whole thin provider network problem. What’s so wrong if only certain hospitals offer care? We Exchange plebes would still get high quality care, as it seems!
Then I searched to see if the doctors mentioned in these lovely stories are in-network on Exchange plans and…..
With very, very (,VERY) few exceptions, none of the cancer care providers mentioned in these feel-good articles were in-network for Exchange plans.
Even the director of the cancer program at Evergreen, Dr. Michael Hunter, is not contracted with any PPO Exchange plans except Community Health Plan of Washington, which gets terrible ratings for not paying even the simplest of claims.
The same holds true for the director of radiation oncology, Dr. Eric Taylor
Cascade Cancer Specialists, the group Evergreen uses for outpatient chemotherapy has been absorbed by our mega cancer center, Seattle Cancer Care Alliance, which has not contracted with Exchange plans.
The Moral and the Shell Game
Moral: Yes, some hospitals have contracted with Exchange insurance plans. However, please don’t go to them assuming that you can get in-network care, even for “routine” cancer. Even I was surprised about this. I thought only our hardest cases would be out of luck and the rest had at least reasonable access to care. The reality is that orgs like Seattle Cancer Care Alliance grow tentacles everywhere. When you eliminate them from the choices, you eliminate most or all of the choices.
Congress addressed the “holes” in insurance policies via creating the “10 essential benefits”. Access to doctors who treat serious illnesses was NOT one of those 10 essential benefits. Thus insurance companies created new holes in their policies, severely curtailing access to treatment for illnesses they have traditionally covered.
The Democrats are too busy protecting Obama to help us. The Republicans are too busy screaming "socialism". We have to protect each other, keep each other informed.