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Tuesday, January 24, 2023

Insured Cancer Patients Continue to Face Barriers to Medically Necessary Treatment, New Report Warns

A new report from a national cancer nonprofit warns that delays and red tape jeopardize patients' access to lifesaving cancer care—even when they have high-quality health insurance.

The report, “Vital Access: How Policymakers Can Streamline the Cancer Care Journey," offers concrete solutions that would ensure the policies that govern our health insurance system are able to keep up with the pace of new cancer treatments and diagnostics. It was produced by The Leukemia & Lymphoma Society (LLS) and Manatt Health, a leading consulting firm with deep expertise in health policy.

“In many cases, the healthcare system we have today has allowed roadblocks to patients' health to persist, rather than opening doors to the treatment they need," said Lucy Culp, Executive Director of State Government Affairs at LLS and co-author of the report. “There's a better way."

Patients' odds of surviving cancer often hinge on their ability to access specialists who can evaluate, diagnose and treat their particular type of cancer as quickly as possible. But too often, patients encounter barriers that prevent them from accessing that care and benefiting from incredible advancements in cancer treatment.

Some blood cancer survival rates have more than doubled over the last 50 years. At the same time, insurance coverage in the U.S. has improved dramatically in recent years, with the uninsured rate reaching an all-time low of 8 percent in 2022, according to the federal government.

However, the new report's findings suggest better treatments and greater insurance coverage still aren't enough to help some cancer patients, who face insurance denials, limited provider options, and complicated appeals processes when insurance claims are denied.

“The good news is, there are tools available to plans, providers and regulators to address many of these continued gaps for individuals that have insurance but are unable to access care," said Alex Morin, Manatt Health Director and co-author of the report.  “But it's clear that we are not taking advantage of them to their fullest potential and as a result, patients and families continue to suffer."

The report was informed by interviews with more than two dozen cancer patients and family members who encountered roadblocks to care. The study, for example, cites the case of J.J. Duncan, a California mother whose son's plan wouldn't cover cutting-edge cancer care that was only available to him in another state. Another patient, based in New Jersey, had to pay on his own for doctor-ordered follow-up imaging because of complicated and time-consuming appeals processes with his insurer. “This experience has forever changed the way I look at health insurance," Duncan said in the report.

The report offers specific recommendations for state and federal policymakers as they work toward developing insurance regulations that advance a more equitable system of care. Chief among them: ensuring access within narrow insurance networks – which are increasingly common in both commercial health insurance and Medicaid – as well as eliminating red tape, streamlining prior authorization and appeals processes, and making it easier for patients to get care out-of-state.​