UnitedHealthcare and Memorial Sloan Kettering Reach Agreement
On Tuesday morning, major insurance providers UnitedHealthcare and Memorial Sloan Kettering Cancer Center announced a new multi-year agreement. This deal ensures that approximately 19,000 patients with UnitedHealthcare and Oxford Health Plan will be able to continue receiving care within their network for cancer treatment.
Not too long ago, tensions rose between the insurance companies and cancer centers during contract negotiations, which went past the June 30 deadline. Many patients found themselves in a scramble to secure compensation or alternative care options.
One patient, Marla Puccetti, shared her experience. She spent an entire day on the phone, trying to connect with both her insurance provider and the hospital where she receives treatment.
“I’ve been put on hold basically all day,” the 53-year-old Puccetti mentioned.
With her current plan not covering out-of-network services, Puccetti would have faced the daunting prospect of paying the full cost of her care, which is not feasible for her. The thought of seeking treatment elsewhere felt overwhelmingly wrong to her.
“It’s scary. I don’t want to go anywhere else,” she expressed. “All my doctors are there. All my surgeons are there. They feel like they’ve saved my life.”
Negotiations between the two entities primarily centered around rising costs for care, something that MSK argued was essential for maintaining the quality of treatment.
UnitedHealthcare indicated that MSK was requesting a 30% increase in payments for facilities and physicians, alongside a 36% hike related to cancer center fees. They noted that consumer costs could soar by $405 million over the next two years.
As for the specifics of the new contract, neither party has disclosed the final terms.
“We recognize how difficult and deeply personal these negotiations can be for patients and families,” stated Junior Harewood, CEO of UnitedHealthcare in New York. “We’re glad to renew our relationship and provide continued access to MSK for those who depend on them for quality cancer care.”
The company claimed that it has offered MSK reimbursements at a significantly higher rate compared to other cancer care providers in the region.
However, Dr. Cardinal Smith, MSK’s Chief Medical Officer, questioned the narrative that cancer centers were inflating costs for patients. She pointed out that their care costs are actually 4% to 16% lower than those at comparable hospitals nearby.
“Our patients get better results due to the total cost of care,” she added.
Smith also mentioned that it’s not just MSK feeling pressured during contract negotiations with UnitedHealthcare; many institutions are facing similar challenges. “This is happening in other institutions as well, reflecting what I think is a deeper tension in our health care system,” she noted.
Puccetti was diagnosed with breast and cervical cancer a few weeks apart in 2021. After undergoing a mastectomy and a hysterectomy, she’s found her breast cancer in remission, while her cervical cancer returned. “I’ve had three recurrences now,” she stated, recalling her extensive treatments which included 60 radiation sessions and over 100 rounds of chemotherapy.
Her current situation is precarious, with her tumor adhering closely to both her bladder and bowels. The doctors have mentioned that surgical removal is possible, yet she faces the grim prospect of living with collection bags if they proceed.
At the moment, she’s undergoing immunotherapy, aiming to stabilize her cancer. Recently, she learned from UnitedHealthcare that MSK might no longer be in her network from July 1.
“It was shocking to realize that this was actually happening,” she said on a recent Monday.
Until the recent announcement, numerous patients like Puccetti had been left uncertain about their ability to continue receiving care at MSK.
Looking ahead, Puccetti is exploring other insurance options. Her UnitedHealthcare plan costs her $3,200 monthly, covering some expenses, yet she still faces significant out-of-pocket costs.
She works full-time in the restaurant industry, juggling cooking and bartending duties.
Additionally, she applied for financial assistance from Memorial Sloan Kettering but hasn’t received any updates regarding her eligibility.
“Everyone kept saying, ‘Don’t panic, they’ll resolve this.’ So I tried not to panic. But, why shouldn’t I feel anxious?” she reflected.
