Texas Cancer Patients May Need New Doctors After Insurance Changes

Seniors undergoing cancer treatment in Texas may need to find a new doctor after Blue Cross Blue Shield of Texas decided to end its Medicare Advantage plan offering at MD Anderson Cancer Center.

That means all doctors working at the cancer center in Houston will no longer be in-network for the seniors relying on either Medicare Part C Advantage plans or managed Medicaid services.

The change will go into effect Friday, leading many to look for a new doctor and course of treatment.

“Medicare Advantage plans are increasingly playing hardball with prestigious medical centers, trying to balance cost control with patient care,” Michael Ryan, a finance expert and the founder of michaelryanmoney.com, told Newsweek.

But the change in Texas is not without its implications, he added.

“MD Anderson isn’t just another hospital,” Ryan said. “It’s one of the world’s premier cancer centers.”

Both seniors who rely on Medicare for their health insurance as well as low-income Texans on Medicaid could be impacted by the change.

Newsweek reached out to MD Anderson and Blue Cross Blue Shield for comment via email.

MD Anderson learned earlier this year that their doctors would no longer be in network, according to Houston Public Media.

While MD Anderson continues to accept Medicare and Medicaid, only certain parts of the insurance will be in-network.

That includes Medicare Part A, which covers many elements of your hospital stay, as well as Medicare Part B, which provides coverage for doctor visits, screenings and preventative care.

MD Anderson previously said they would work with patients to help them find another healthcare provider during their treatments.

“While MD Anderson welcomes the opportunity to remain in-network for BCBS Medicare Advantage and Texas Managed Medicaid services, our goal is to ensure continuity of care for those in active treatments,” MD Anderson said in a statement.

“The institution is in touch with affected patients and is working with Blue Cross Blue Shield on coordination of care for patients enrolled in the BCBS Texas Medicare Advantage and Texas Managed Medicaid plans.”

This isn’t the first time Blue Cross Blue Shield of Texas has faced issues with its Medicare Advantage plans. Baylor Scott and White, another provider in Texas, almost ended its in-network agreement with the major insurer as well but was able to secure a new agreement just before the October 1 deadline.

Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, said many health insurance providers have dropped coverage in markets due to rising costs and failure to make profits.

“In this situation, it’s hard to say if that’s the case, because not much information was provided outside of the agreement between the provider and MD Anderson coming to an immediate end,” Beene told Newsweek.

“The good news for those receiving benefits from the provider is they’ll be assisted in transitioning to another Medicare Advantage program MD Anderson does accept for coverage. However, it opens larger questions about the solvency of Medicare Advantage programs offered through certain providers in not just this market, but others.”

Chris Fong, a Medicare specialist and the CEO of Smile Insurance Group, said while insurance companies are attempting to save money by reducing the costs of services and adding on steps like prior authorization or referrals, medical centers are also experiencing inflation on medical supplies and doctor salaries.

“Unfortunately, the patients are some of the most affected through these contract negotiations,” Fong told Newsweek. “The advice we give to our clients is to look at how they would like their healthcare to operate. If they prefer the flexibility to choose doctors and medical providers with less limitations, they should consider traditional Medicare with a supplement and prescription plan.”

Ryan said insurance companies are increasingly using ‘network narrowing’ as a cost control strategy.

“They’re betting that by excluding expensive providers, they can offer lower premiums,” Ryan said, adding that they don’t always consider the human cost.

For the impacted seniors, Ryan said they have options, but timing matters.

“Sometimes a Medicare Supplement plan (Medigap) offers more flexibility than Advantage plans, especially for specialized care. Yes, it might cost more monthly, but the access to any Medicare provider could be worth it,” Ryan said.