What's New
A contract between health insurer Anthem Blue Cross Blue Shield (BCBS), which provides coverage to nearly 5 million New Yorkers, and Memorial Sloan Kettering Cancer Center may expire without renewal in the new year.
Why It Matters
Anthem BCBS, one of the nation's largest health insurers, has an agreement with one of the country's top cancer hospitals, Memorial Sloan Kettering Cancer Center (MSK), set to expire on January 1, 2025. It is not rare for health insurers and hospitals to negotiate contracts up until the expiration date.
The care center said in a press release last updated December 12, "At this time, we are not confident that a deal will be reached before our contract expires on January 1, 2025. Anthem continues to stall negotiations and refuses to make any effort to provide MSK with adequate reimbursement."
However, in a December press release, Anthem said that the company remains "optimistic" and "confident" an agreement will be reached.
If the agreement expires on January 1, MSK and Anthem have repeatedly noted that New York State's "cooling off period" will allow patients to receive care at in-network rates until March 1, 2025.
According to the New York law, "If a contract between an HMO or insurer and a hospital is not renewed or is terminated by either party, the parties are required to continue to abide by the terms of the contract for two months from the date of termination or, in the case of a nonrenewal, from the end of the contract period."
In a press release sent to patients on December 18, MSK confirmed that "patients who are no longer in active treatment are still eligible for in-network follow-up care at MSK until April 1, 2025."
What To Know
The cancer care center wrote in the press release, "While MSK continues to seek a fair agreement that will keep services in network for Anthem members, Anthem has not reciprocated this effort."
Earlier this year, the hospital sent letters informing patients of the potential loss of coverage.
MSK says that low reimbursement rates are "not sustainable" for the health system and that "Anthem will force MSK out-of-network if they continue to refuse to pay rates that reflect the true cost of providing the world-class care our patients deserve."
The hospital says they have been "underpaid" by Anthem for years, writing, "Currently, Anthem pays MSK at rates that are 34% lower than those of other NCI-Designated Cancer Centers in Manhattan."
There are 72 National Cancer Institute-designated cancer centers in the U.S., with five in New York City. Andrea Fassacesia, senior director of media relations at MSK, told Newsweek that the hospital works with a data vendor "to obtain data around hospital and payer rates. We have looked at a subset of comparable hospitals in the NYC region, which is how we concluded on the 34 percent less number."
The hospital's analysis of reimbursement data from 3 NCI-designated hospitals in Manhattan was performed in August 2024, and the rate files have not changed, Fassacesia told Newsweek.
"The analysis looked at every CPT/HCPCS [billing] code for outpatient or revenue code for inpatient that corresponds to those used at MSK," Fassacesia said. She added, "We quantified the results by hospital only looking at codes that both hospitals have rates reported quantified by MSK's 2023 volume activity."
But Anthem countered the lower reimbursement rate in their press release, writing, "MSK is a world-class cancer institute and is currently paid accordingly. In fact, Anthem currently reimburses MSK at rates at or above other national cancer Centers of Excellence."
Newsweek has requested clarification and confirmation on this from both parties.
An Anthem spokesperson told Newsweek, "Anthem recently offered MSK generous payment rate increases, and we are awaiting their response in hopes that we can reach a resolution."
For the hospital's 22,000 active patients undergoing treatment, the center has confirmed they will receive "Continuity of Care, which allows them to maintain their in-plan coverage for treatment at MSK through the duration of their treatment."
The hospital noted that this extends beyond March 1, 2025, and "Anthem will continue to cover planned treatment until it has been fully administered and a patient is considered clinically stable." MSK said it will notify Anthem of qualifying patients, and individuals do not need to take any action.
The insurer noted in its press release other cancer centers patients could receive care at other New York institutions, including NYU Langone's Perlmutter Cancer Center, Montefiore's Einstein Cancer Center, Columbia University's Herbert Irving Cancer Center, Mount Sinai's Tisch Cancer Institute, among others.
Earlier this month, Anthem BCBS drew criticism for its recent policy change that would no longer reimburse anesthesia services for the complete duration of certain surgical procedures, opting for a partial coverage model. The move drew national outrage, especially from doctors and patients, with the president of the American Society of Anesthesiologists (ASA), Dr. Donald Arnold, calling it "appalling" and "egregious," creating a precarious situation for patients undergoing surgery.
On December 5, the insurer abruptly reversed the policy, which was set to take effect in February in Connecticut, New York, and Missouri.
What Happens Next
If the contract is negotiated and agreed upon, it will likely occur ahead of its expiration on January 1, 2025.
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