New Yorkers buying a health plan on the state’s new insurance exchange should read the fine print if they’re interested in getting care at some of the city’s top hospitals. Not all are participating in the new plans created by Obamacare.
As of this week, not one of the plans for sale on New York’s health benefit exchange would cover treatment at Memorial Sloan-Kettering Cancer Center, one of the world’s largest and most respected cancer hospitals.
That could mean that the 615,000 individuals and 450,000 small-business employees expected eventually to get their insurance through the exchange would have to go someplace else for treatment or pay the bill out of their own pockets.
Other premier city hospitals are in the networks of just a few of the new plans. NYU Langone Medical Center has signed agreements with four of the 19 insurers doing business on the exchange. New York-Presbyterian Hospital, which oversees the city’s biggest hospital system, has signed agreements with just six insurers.
President Barack Obama promised when the Affordable Care Act was enacted that people who liked their doctors could keep them, but the reality of the law both in New York and around the country is that the new lower-cost policies it is creating sometimes have smaller provider networks than Medicare, Medicaid, or the plans people typically get through their employers.
Those narrower networks are a result of insurers trying to control costs and hospitals being cautious about agreeing to take new, untested insurance products.
Negotiations at several hospitals were ongoing, and it is possible some insurer networks will grow by the time policies take effect on Jan. 1.
“We want to be accessible and expect to be in network with one or more ACA plans,” Sloan-Kettering spokeswoman Caitlin Suzanne Hoo said Wednesday. She added that patients currently undergoing care shouldn’t worry about a disruption. “We would never stop a patient’s treatment because of a change in insurance or financial situation.”
Empire Blue Cross and Blue Shield, one of the health plans that failed to reach an agreement with Sloan-Kettering, hinted that cost was a factor.
“Our choices relating to network composition have been motivated by our goal of supporting access to a broad range of care on an affordable, sustainable basis,” spokeswoman Deb Wiethop said in an email. “Affordability is key to a more focused network.”