MSK will no longer be covered by Anthem Insurance
We just received a letter that my cancer center, Memorial Sloan Kettering, will most likely no longer be covered by our insurance Anthem (Blue Cross Blue Shield) starting January 2025. Is anyone else in the same boat? Has anyone gone through the same experience with their insurance cutting off coverage for their medical care? I'm making calls tomorrow (to MSK, Insurance and HR dept) but just wondering what can be done? I just switched treatments and dealing with insurance has been a nightmare. Now I may not even be covered. Thanks for any insight.
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Hi @smallmoments, I got one of those letters as well. It doesn't affect me as much since I used MSK for second opinions. When I called Anthem I was told that they had not been able to agree on a fee structure with MSK so they were pulling out of their system to save the company money. There is a possibility that a deal might happen before the end of the year but things don't look good now.
There is some wording in the decision that says in certain instances Anthem would cover treatment at MSK for the first 90 days of 2025 for "continuity of care" but that would be decided on a case by case basis. This situation really sucks but is beyond our control. You should probably investigate your best alternate options so that you can make the switch if necessary. I am not a fan of Anthem given the number of appeals I have had to file (even though I prevailed in all of them) but there is not much you can do if you are locked into their system by employee/retiree insurance. You have my sympathy.
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@smaillmoments, the same thing happened last fall with MSK and Cigna. MSK put out a call to arms asking patients to contact the insurer and protest. They did eventually settle. But it was late, after the time when many patients had to make decisions about their insurance coverage.
All this feels like two entities duking it out in public for a negotiating edge. I am guessing they will work it out but, of course, there is no guarantee. Makes me wonder what's going on at MSK, as I haven't heard of the same issue with other hospitals. The press release below (perhaps this is the notice you received) said MSK is asking for double-digit increases for the next three years.
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In Australia we have an issue with oral morphine and saline at the moment. I find it really disturbing that our government seems reluctant or is unable to fix the issues.
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I'm in a similar boat and it is stressing me out and pissing me off.
I will ask my oncologist what suggestions she has in case this goes through, but I am trying not to borrow trouble, as I really hope my insurance will be able to work it out.
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Quick update - I have my insurance through the NYC DOE. I double checked the info and it looks like if we were already receiving treatment, we can continue to receive treatment. I don't know if that's the case for all of these negotiations, but maybe this applies to you as well!
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I was sent further info that if you are in active treatment you can continue with MSK. You cannot begin treatment or have follow up care covered after 3/31/25 (there is a cooling off period until that date.) This doesn't apply to me but my MO said she can and does consult with doctors at MSK. My bone tumor radiologists got a second read on my MRI from a bone tumor radiologist at MSK but they return the favor if MSK wants an out-of-hospital opinion. There seem to be workarounds if both hospitals benefit.
According to MSK this dispute arose when a transparency in pricing law went into effect and MSK saw they were being unfairly compensated compared to other local hospitals. Who knows?
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Hi all. Thanks for everyone's answers and insight. I just got a second letter yesterday from MSK that an agreement has not been reached with Anthem (the tone is not hopeful). In any case, I thought I'd share some notes on what I've learned along the way for those dealing with this $hi+show. Please note that I'm still doing the leg work on this so nothing has been finalized (it's all very confusing and no one seems to have definitive info):
- Yes, there is a possibility of Continuity of Care (CoC) but more than likely this is temporary even if you have been in treatment at MSK before March 2025. From what i understand, CoC needs to be approved by the insurance company (Anthem in this case). The MO's office needs to write and send documents supporting why Anthem needs to cover a patient who will use an out of network provider (which MSK will be if an agreement is not reached). Anthem will then decide how long this coverage will be but it's not permanent (it's too expensive for them to do this). As we know, we'll be on treatment forever so. . . . Again, this is from my understanding from talking to multiple Anthem supervisors and also the insurance billing specialist at the MSK. Also, someone told me that CoC documentation takes a while (filling out forms, back and forth between insurance company and MO's office, etc) so if you are thinking of going down this path, start talking to your MO's office and Anthem early.
- I'm investigating switching to Medicare since I've been on SSI for the last two and a half years. I've got to look at supplements etc for current and future treatments. Will probably use an medicare broker (I have a couple of recs from friends) since enrollment period starts this week.
If any of the MSK/Anthem patients find out additional or different info, please share on this thread. It's the last thing any of us need to deal with and it's just so maddening!! Good luck everyone.
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Smallmoments, thank you so much for this. I also got that letter and it got me worried right into inaction. Sigh. I will call Anthem and try to start the paperwork. And also may start asking my doctors for referrals. I hate this so much.
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