Anthem Blue Cross contract fight could see 22K Sloan Kettering cancer patients lose life-saving treatments
An all too typical story
Thousands of Memorial Kettering patients could lose access to life-saving treatments in 2025 because of an ongoing contract fight with insurance giant Anthem Blue Cross Blue Shield.
MSK leadership said Wednesday it was “not confident” a deal would be reached between the two sides before their current contract expires on Jan. 1, 2025 — which would push some patients out of network and force them to drop the treatments or face impossibly high medical costs.
“I feel like once you have cancer … you live to scan to scan,” said teacher and mother of four Carrie Regan, 41, who called the thought of losing care at MSK “crippling.”
The Hudson Valley resident was diagnosed with ovarian cancer in August 2023 and has been cancer-free since March — but she still goes for monthly checkups and said she has been frustrated by the lack of answers from Anthem.
“So on top of that anxiety now we have this level of anxiety that like what am I gonna do, who am I going to see,” Regan added.
MSK and the insurer are at loggerheads over the rate of reimbursement Anthem would give the medical institution — with the hospital’s chief financial officer accusing Anthem of putting “profit ahead of patient care.”
Some built-in safeguards extend coverage for 90 days after a contract expires.
Anthem painted a more optimistic tone in a statement to The Post, saying the company is “confident we will reach an agreement with Memorial Sloan Kettering (MSK) as we continue to negotiate in good faith.”
The health insurance behemoth also claimed it was offering “generous” rate hikes to MSK.
“Anthem recently offered MSK generous payment rate increases, and we are awaiting their response in hopes that we can resolve this,” an Anthem spokesperson said in an email.
“Even as MSK has demanded drastic price hikes that would dramatically increase prices for MSK patients covered by Anthem and their employers, we have recently reached collaborative agreements with several other prestigious New York City health systems and continue to believe we will do the same with MSK.”
The impasse comes as health insurance companies have faced heightened scrutiny following the cold-blooded murder of UnitedHealthcare CEO Brian Thompson on a Manhattan street on Dec. 4.
Anthem faced heat earlier this month when it emerged the insurance company was going to place limits on the amount of time it covers for anesthesia while patients are under the knife, but quickly reversed course after fierce public outrage.
“Whether it’s an ill-advised policy to deny anesthesia coverage for surgical patients or refusing reasonable reimbursement rates for the most cost-effective cancer care provider in the Northeast, Anthem continues to show it puts profit ahead of patient care,” Harrington, the CFO, said Wednesday.
MSK contended that Anthem has underpaid MSK for years at a 34% lower rate than other National Cancer Institute-Designated Cancer Centers in Manhattan.
The rate increase proposed by MSK would mean the hospital is reimbursed at least 10% less compared to similar medical centers, Harrington said.
Comments from the author:
Insurance companies along with their pharmacy benefit managers have become the ‘robber barons’ of the health industry.
CEOs set a profit margin to satisfy stockholders, regardless of their responsibility to patients and providers. Both Anthem and United Health Care have the highest profitability in the industry, they continue to bully hospitals and providers alike cutting reimbursements, denying care, and provoking hospitals to terminate contracts to avoid losing critical income.
It is a well-known fact that hospitals lose money treating Medicaid patients and barely break even treating Medicare beneficiaries. Managed care also decreases hospital income. Anyone looking at their explanation of benefits will see that frequently a hospital bills $100,000 for a service and the MA plan pays about $20,000.
What is going on? Read part II later this week for the answers.
I am puzzled. Medicare and Medicaid pay little for care, to the point some doctors feel treating Medicaid patients actually costs them money. Private insurances generally pay a premium but regulate who participates. If the profit incentive is removed, why have private insurance at all? I am not saying there aren't gross distortions in the current system, just trying to reach where this article is going. The bias seems to be against Anthem. How dare they make a profit! Notice how rapidly Anthem caved when it attempted to limit anesthesia "times and reimbursement", a turnaround impossible in a government run program. That is the market at work. What option exists for Medicare or Medicaid as they have done the same thing, only couched it in slightly different terms with a very low reimbursement level. As a private practitioner I accepted all forms of insurance and even people with no insurance, which usually meant a complete write-off. The private insurances helped keep our office open. Now, with agencies hiring most doctors, paying their salaries, etc., how would Sloan negotiate with the Federal government without using its clout through its representatives?