Skip to main content

Helping Patients Access Out-of-Network Care

Key Findings From a Scan of Four States

The Problem

For blood cancer patients, managing their own care can be daunting. They must obtain the right treatment, at the right time, from the right provider—all at an affordable cost. And with their lives at stake, there isn’t room for error. A Manatt Health report, commissioned by LLS , looks at how patients navigate their cancer care journeys—and how policy challenges hamper their ability to navigate and obtain proper treatment.

The Solution

This report examines the unique policy and regulatory framework used in four states and details policy mechanisms that states can deploy to help patients. Recommendations include:

  • Adopting robust network adequacy standards – or refining current standards – to ensure patients have access to a wide-range of providers
  • Holding insurance plans accountable for maintaining high-quality networks by requiring notification to regulators when changes occur and taking action as necessary
  • Simplifying the patient experience through increased transparency and streamlined appeals and grievances processes
  • Investing state resources in departments of insurance. State regulatory bodies with more resources can more effectively engage with both plans and consumers, and they can develop tools to support consumers as they navigate the marketplace
  • Providing enhanced, easy-to-understand educational information and support services to providers and patients about how they can appeal insurer decisions
  • Implementing protections to ensure access to medically necessary cancer care even when out-of-network, or when cost-sharing or other factors may put it out of reach. These policies should be structured to protect and support the most vulnerable populations. 
  • Developing and enforcing cancer care-specific network adequacy standards that would ensure all networks allow timely access to cancer-care services

Learn more by viewing our out-of-network care infographic, below.

Infographic: Maze