Accessing Out-of-Network Subspecialty Cancer Care in Marketplace Plans

Prepared in partnership with The Leukemia & Lymphoma Society

Blood cancer takes a demanding physical, mental and emotional toll on the 1.3 million patients living with this disease in the U.S. Many blood cancer patients also face the daunting task of managing their own care—obtaining the right treatment, at the right time, from the right provider, at the right cost. That process is not always simple, and patients with blood cancer face numerous obstacles when navigating their care.

These challenges can be exacerbated by provider networks—the list of providers and hospitals that a patient’s insurer has contracted with to provide care. When these networks are limited, patients may face barriers that prevent them from accessing appropriate care due to high out-of-pocket costs associated with out-of-network care. Researchers and advocates have documented the increased existence of and enrollment in narrow-network insurance plans, particularly within the individual market. While the Affordable Care Act provided protection for patients from catastrophic cost sharing for in-network services, limits on cost sharing do not automatically apply to out-of-network cost sharing.

In a new report prepared in partnership with The Leukemia & Lymphoma Society, Manatt Health reviews policy challenges that may hamper patients’ ability to navigate their options and obtain proper treatment for their cancer. To ascertain the perspectives of state regulators, insurers and cancer care providers, the report focuses on four states and their policy and regulatory frameworks governing marketplace plans.

To read the full report, click here.



pursuant to New York DR 2-101(f)

© 2023 Manatt, Phelps & Phillips, LLP.

All rights reserved