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Insurers exclude some potential patients from Roswell Park

WASHINGTON – The Affordable Care Act may be increasing access to health care for millions of Americans, but it’s excluding some potential patients from going to Roswell Park Cancer Institute and other top comprehensive cancer care centers.

In a survey of 23 of the nation’s top cancer hospitals, the Associated Press found last week that of the 19 that replied, only four said that all the insurers offering coverage on their state’s exchanges allowed patients to visit those comprehensive cancer centers.

In the Buffalo area, five of the seven insurers on the state insurance exchange allow patients access to Roswell Park. And statewide, 11 of the 16 insurers won’t cover visits to Buffalo’s widely respected cancer center.

“The question has to be asked: Why?” said Dr. Willie Underwood III, a urologic oncologist at Roswell Park who’s allied with its Office of Cancer Health Disparities Research.

The two local insurers that do not cover visits to Roswell Park are Fidelis Care and MVP Health Care. Spokespeople for the two insurers, which are both based in the Albany region, did not respond to requests for comment.

Rep. Brian Higgins, a Buffalo Democrat and one of the leading congressional advocates of cancer care and research, acknowledged that many insurers have narrowed their provider networks for plans they offer on the new health care exchanges in order to hold down costs.

But excluding comprehensive cancer care centers from an insurer’s network is a step too far, said Higgins, who is otherwise a strong supporter of the Affordable Care Act, or “Obamacare.”

“This just needs to be fixed,” Higgins said. “There needs to be an administrative fix to it, but all cancer patients should have access to the highest quality of care.”

Higgins and Rep. Tom Reed, R-Corning, are preparing a letter to Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, to express their concerns about the issue and suggest changes that would ensure broader access to comprehensive cancer centers under the health reform law.

Underwood stressed that overall, the Affordable Care Act still increases Roswell Park’s pool of potential patients. That’s because most of the people buying insurance on the state exchange did not previously have health insurance.

But still, Underwood said it’s a problem if insurers are excluding patients from the nation’s top cancer centers.

“The goal is to improve the health and health care of the nation,” he said. “To create a situation that means that some people are excluded from these facilities is probably not within the intent of the law.”

Some 91 percent of Roswell Park’s patients come from the eight counties of Western New York, while 6 percent come from other parts of New York State and 3 percent come from outside the state or outside the country.

Roswell has been trying to broaden its service to people from other parts of the state – and Higgins said that will only get more difficult if insurers outside the region are not allowing their subscribers to go to Roswell Park.

“This is a regional facility that depends both on residents and nonresidents,” Higgins said.

And while Underwood acknowledged that the overall number of patients being excluded from Roswell Park may be small, the consequences of that exclusion are not.

After all, Roswell Park and the nation’s 41 other comprehensive cancer care centers offer access to clinical trials and other specialized treatment not available at other hospitals.

“It may be five people who are affected, but for those individuals, this matters 100 percent,” Underwood said.