Re “Patients struggle to find covered doctors,” Feb. 5
The article points out a major gap in the implementation of the Affordable Care Act: Many specialty providers and hospitals that cancer patients rely on are being left out of insurance exchange plans. Because out-of-network expenses do not count toward a patient’s out-of-pocket maximum, cancer patients enrolled in some exchange plans could be responsible for thousands of dollars of medical expenses.
The article also raises a larger issue: the lack of transparency by payers in these insurance marketplaces. As the lymphoma patient in the article noted, she thought she had done her due diligence to identify an appropriate plan to fit her very complex needs, only to learn too late that she was mistaken.
Advocacy groups such as ours are working to address both the network adequacy and transparency issues so that patients can gain access to high-quality, affordable, coordinated care.
Mark Velleca, MD
The writer is the chief policy and advocacy officer at The Leukemia & Lymphoma Society.