Accessing Out-of-Network Cancer Care: Policy Challenges & Solutions

Plus, Lucy Culp, Executive Director, State Government Affairs, LLS

In a New Webinar, Manatt and the Leukemia & Lymphoma Society Share the Obstacles Cancer Patients Face to Receiving Proper Treatment—and the Policies States and Plans Can Implement to Improve Network Adequacy and Access.

Blood cancer takes a demanding physical, mental and emotional toll on the 1.3 million patients living with this disease in the United States. Many blood cancer patients also face the daunting task of managing their own care—a process that is fraught with obstacles. Challenges are exacerbated when provider networks are limited, raising barriers that prevent patients from accessing appropriate treatment due to high out-of-pocket costs associated with out-of-network care.

In many cases, patients may be able to receive medically necessary out-of-network care with in-network levels of cost sharing. However, doing so often requires patients to navigate their plans’ coverage determination and appeals processes, which can be complex and time intensive.

In a new webinar based on a just-released report, Manatt Health and the Leukemia & Lymphoma Society (LLS) examine policy challenges that hamper patients’ ability to obtain proper treatment for their cancer. Based on a review of four states and their policy and regulatory frameworks governing marketplace plans, the webinar examines the findings through the lens of a patient navigating the cancer care journey. Key topics will include:

  • Background on the regulatory landscape and its impact on cancer care access
  • The complexity of the patient journey from diagnosis to treatment, particularly when care is needed outside of the patient’s insurance network
  • Coverage-associated rules put in place by plans and states, including findings from interviews with state regulators, insurers and cancer care providers
  • Variations among state regulatory frameworks governing plan network development, network maintenance, appeals and grievance rights and processes, and other cancer care-related consumer protections
  • Opportunities and best practices for enhancing regulatory frameworks and improving the customer experience

Presenters:

Joel Ario, Managing Director, Manatt Health
Alex Morin, Director, Manatt Health
Lucy Culp, Executive Director, State Government Affairs, LLS

Date and Time

Thursday, September 2, 2021
 


If you would like to receive an audio transcript of this webinar due to accessibility issues, please email us at webinars@manatt.com.

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