January 29, 2014
Will major cancer treatment centers accept exchange plans?
Cancer treatment centers will accept most insurance plans, although they may only be considered "in-network" in select plans.
For example, Sloan-Kettering lists the following exchange plans as in-network: Health Republic Insurance (New York), Oscar Insurance (New York), Oxford Health Plans (New York), Health Republic Insurance of New Jersey (New Jersey). NOTE: Patients with other plans may be considered out-of-network and members should contact their health plan for information specific to their plan.
For example, the Mayo Clinic hospital in Minnesota (Rochester) uses a state-based exchange, while the Mayor Clinic in Arizona (Scottsdale) relies on the national health exchange. According to the Minnesota Mayo Clinic, "very few" of the exchange plans consider the Mayo Clinic in-network. The Mayo Clinic was careful to note that they will treat any patient, but out-of-network insurers may not cover the full expense. When contacted, the Mayo Clinic in Arizona could not verify whether or not they are considered in-network for exchange plans, other than to verify they will keep their existing contracts in place.
Both Mayo Clinic locations are instructing potential patients to contact their health provider with the Mayo Clinic federal tax ID to find out if their plan considers the hospital in-network.
Can doctors choose to not accept exchange-based health plans?
Doctors may choose to contract with any carriers or health plans that they deem acceptable. Similarly, they can choose to not contract with health plans or carriers that don't meet their needs. Doctors have always had this freedom of contract, and the Affordable Care Act has not changed this.
Is there a difference in networks between exchange plans and non-exchange plans?
Yes. According to an Anthem representative, hospital networks are specific to each individual plan, even between different plans under the same carrier.
More Information:
A list compiled by Watchdog.org of the in-network exchange plans accepted by the top 18 hospitals in the country