BCBS Drops MD Anderson

[somarco]

Blue Cross Blue Shield of Texas is terminating its Medicare Advantage and managed Medicaid contracts with MD Anderson Cancer Center, effective Nov. 1.

"While MD Anderson welcomes the opportunity to remain in-network for these plans, our goal is to ensure continuity of care for those in active treatments," a spokesperson for the Houston-based hospital told Becker's.

BCBS Texas drops MD Anderson from Medicare Advantage, Medicaid networks

"Blue Cross Blue Shield of Texas terminates Medicare Advantage and managed Medicaid contracts with MD Anderson Cancer Center, impacting thousands of patients. M

www.beckershospitalreview.com

 

[kgmom219]

Something screwy is going on with BCBSTX MAPD and PDP.

 

[annon123]

There was a fight between BCBS in MS several years ago (involved all everything) and U of MS Medical Center with respect to any BCBS of any kind. Coverage was terminated and it took around a year for the two of them to get to an agreement so people with BCBS under any plan - employer, MAP, etc. could use them again. In this case it was a fight over reimbursements and prior authorizations and negotiations were stalled.

And this is why, in my opinion, it is risky to have MAP's (at least in MS) as no client can guarantee they will never need speciality care. However terminating cancer patients at MDA is a real issue as they are the number 1 cancer center in the country and while there are some other decent choices in Houston, that may not be the case elsewhere like was in MS.

 

[somarco]

risky to have MAP's (at least in MS) as no client can guarantee they will never need speciality care.

Several agents on the forum claim their MA clients never need/want special care for cancer . . . so it does not matter if their plan is not accepted at MD A, City of Hope, Mayo, Johns Hopkins, Sloan Kettering . . .

 

[annon123]

Several agents on the forum claim their MA clients never need/want special care for cancer . . . so it does not matter if their plan is not accepted at MD A, City of Hope, Mayo, Johns Hopkins, Sloan Kettering . . .

And those clients may well change their mind if they actually get a cancer diagnosis if they are not ready to die.Those clients also clearly don't know that research documents that care at the major, highly ranked cancer centers like the ones you posted means you, on average, have better outcomes than at community oncology centers and lower ranked other cancer centers including university ones. A personal example: When I had a blood cancer MDA had me do a treatment that the local university cancer clinic had never heard of (I had it prescribed at MDA and implemented locally). It was a newer treatment that was more effective and had fewer side effects. Of course MS is last in the nation for health care...

I would doubt those agents making those claims actually know the future medical issues all their clients will eventually get. Heck doctors don't even know that for any of us.

 

[Medicare bro]

Several Hospitals across the country are MD Anderson certified. Advent heath hospitals are. What is the difference.

 

[InsuranceGuy29]

Several agents on the forum claim their MA clients never need/want special care for cancer . . . so it does not matter if their plan is not accepted at MD A, City of Hope, Mayo, Johns Hopkins, Sloan Kettering . . .

At this point, many hospitals across the United States have amazing cancer treatment down to a science. Every state and major metropolitan area has at least a few University Medical Center hospitals that all rank super high nationally in cancer treatment. It's not 1989 anymore, where Mayo or MDanderson were "it." Just around me, I have University of Chicago Hospital, Northwestern University Hospital, and Rush University Hospital. These all rank super high nationally. Moreover, most people cannot afford to travel to those few hospitals, like Mayo and MdAnderson to get constant treatment.

 

[annon123]

At this point, many hospitals across the United States have amazing cancer treatment down to a science. Every state and major metropolitan area has at least a few University Medical Center hospitals that all rank super high nationally in cancer treatment. It's not 1989 anymore, where Mayo or MDanderson were "it." Just around me, I have University of Chicago Hospital, Northwestern University Hospital, and Rush University Hospital. These all rank super high nationally. Moreover, most people cannot afford to travel to those few hospitals, like Mayo and MdAnderson to get constant treatment.

You are wrong. That is not true for 18 states in this country if you look at the US News and World Report list and for 12 states if you look at the National Cancer Institute (NIC) Designated Cancer Centers list. Rankings and NIC designation matters for cancer outcomes.

For example MS is last in the nation for health care and the university medical system is joint commission D rated, doesn't even make the list US News and World Report list for cancer treatment, and is not NIC designated. The city capital is where the university medical center and medical school is located. It's the only university hospital in the state. The only other cancer center in this state's city capital and surrounding area is a Community Oncologist practice which means no specialists. It is not possible for oncologists to keep up with all cancers to give patients the best treatments for every cancer out there. That is why is it critical for cancer patients to go to where there are sub specialists in oncology if they want the best outcomes - or at least to get a second opinion on biopsies and treatment at one. There are certainly some big cities in multiple states (like Chicago) that have multiple outstanding cancer centers but a number of them do not and some states don't have any.

Many MAP's are not good state wide in some states and so even within many states you'd still need OM to be able to be seen at a good cancer center.

Also what many of those top centers do is order a plan of treatment which is then implemented locally so patients only go there a couple of times a year which is far more affordable. If that patient is low income often social services pays for their hotel room. Research has documented that outcomes are better when the patient uses a highly rated cancer center.

Go look here:

https://health.usnews.com/best-hospitals/rankings/cancer

The top 49 centers (ranking stop after that and they switch to unranked high performing, etc.) are in 21 states. If you count the high performing centers you are up to 32 states plus DC. And to get into the high performing list, you only need to have one kind of cancer treated listed as high performing.

Or go look here:

NCI-Designated Cancer Centers

NCI-Designated Cancer Centers are at the forefront of NCI-supported cancer research efforts at universities and cancer research centers across the United States.

www.cancer.gov

There are only National Cancer Institute (NIC) Designated Cancer Centers in 36 states. That designation matters for cancer outcomes as they are far better if treatment is ordered by NIC Designated Cancer Centers (and at other top ranked centers).

And sometimes there is only one good cancer center in one city in a state. In a large state the travel distance a 6 or 8 hour or more drive to get to that cancer center from where the person lives. No different than driving from Jackson, MS to Houston to be seen at MD Anderson Cancer Center (#1 cancer center in the country). Except you can't do that with a MAP in MS.

So your assumption because of what is true in the greater Chicago area is far from true in many parts of the country. Yes people in big cities like NYC, Boston, LA, Chicago, Cleveland, etc, are likely in luck with a MAP. There are multiple highly ranked centers in those places (and a few other cities) so they are good to go. But you have entire states with nothing or only one center and it is far away from where the person lives. For example in Michigan, the only center is in Ann Arbor. If you lived in the west end of upper peninsula of Michigan you could easily have a 10 hour drive to get there. There are other excellent centers out of state that are closer. And, if, like in MS, a number of MAPs are regional rather than state wide, some people may still be out of luck even in state with an MAP.

Be careful how you generalize what goes on in a few areas of the country to the rest of the country. Your clients may well be out of luck. There will be some clients better served by OM plus a supplement. That can still be cheaper than having an MAP and hitting the MAP's maximum out of pocket. The transportation costs to a good center may be as far or further when looking at an MAP vs OM in some areas of the country.

 

[annon123]

Several Hospitals across the country are MD Anderson certified. Advent heath hospitals are. What is the difference.

Research documents that outcomes are best using the main campus of these systems that buy up other hospitals and not one of the "other" centers. Mostly what happens is centralizing billing, etc. not hiring an all new, better qualified staff. Same staff, new name or new "certification". MDA has no MDA certified centers on the best cancer center lists. That matters for cancer outcomes. To get on those lists they have to have much better than average outcomes, etc. for their cancer patients. Most cancer patients care about that kind of thing as they are not ready to die of cancer. Of course some people don't know or understand about these kinds of differences. And then they only care once they actually get cancer or some other serious disease where topnotch care is not available in network. Or at all if your MAP doesn't cover any out of state care even if it is out of network.