By Laura Bourdeanu, NP, PhD
Many health insurers who offer medical treatment plans only manage to cover a small number of healthcare providers. They do so in order to offer lower premiums on their health packages. They may do this because healthcare providers that they choose to contract have lower reimbursement rates, thus lowering the overall premium of their packages.
Not including higher cost and better quality, healthcare providers can allow the premiums to be lowered so the healthcare packages become cheaper, but the level of healthcare quality may not be the same. In cost and quality intensive treatments such as those of cancer, the narrow (range of) networks (healthcare providers), that many health insurers opt for, can affect the treatment quality significantly.
National Cancer Institute and National Comprehensive Cancer Network Designated Cancer Centers are known throughout the US as leaders in scientific research in cancer. They have a number of expert specialists in the field of cancer treatment and the highest safety standards.
They have been known to have lower mortality rates particularly amongst their advanced and severely ill patients. They attract many patients who require more advanced care. Being recognized means that these institutions can charge a significantly higher reimbursement figure from health insurers. Therefore, many health insurers may choose to exclude them from their portfolio of medical providers.
A study published by the American Society of Clinical Oncology in the Journal of Clinical Oncology examined how the narrow networks by health insurers can potentially affect the quality available providers especially for cancer patients.
Researchers found that insurance plans with fewer oncologists to choose from were more likely to exclude the providers at National Cancer Institute (NCI)- designated cancer centers. In areas that had NCI-designated cancer centers only 39.4% of the oncologists affiliated with the center were covered by insurance. In areas that did not include NCI-designated cancer centers, the insurance coverage was higher, at 49.9%. In other words, the physicians that were covered by the narrow-network insurance were less likely to be affiliated with an NCI-designated cancer center.
What do these findings mean for you? If you want access to the state of the art cancer treatment center or oncologist, (generally affiliated with NCI-designated cancer centers) then you want to avoid a narrow network health insurance plan.
All the figures in the world mean nothing to the individual if they are suffering from cancer and cannot find the right treatment AND the right treatment may not be available with a narrow network health insurance plan. If you are only able to afford a narrow network health insurance than you may want to at least confirm that your treatment plan is consistent with that recommended by the guidelines, which are generally those used by oncologists in NCI-designated cancer centers. You can either get a second opinion or consult sites like OncoGambit.