Memorial Sloan Kettering and Anthem Blue Cross Blue Shield have deal on rates

Memorial Sloan Kettering Cancer Center and Anthem Blue Cross Blue Shield on Monday reached an agreement on reimbursement rates, sparing 22,000 patients on Long Island and elsewhere from being forced to either look for new doctors or potentially pay thousands of dollars in out-of-network costs.

"Oh, my God, what a relief," said Memorial Sloan breast cancer patient Lori Finn, 60, of Massapequa, after Newsday informed her of the agreement. "I don’t want to have to find new doctors. I like my doctors. I’m happy where I am."

Finn obtains care at Memorial Sloan’s Uniondale location, one of three on Long Island, in addition to Commack and Hauppauge.

The current contract that details the reimbursement rates Anthem pays the Manhattan-based cancer center for patient care expires Jan. 1. Memorial Sloan is in-network for Anthem Blue Cross Blue Shield members. If an agreement hadn’t been reached, members would have had to pay significantly higher out-of-network costs if they continued to use Memorial Sloan, or they would have needed to seek in-network care from another health care provider.

"If you go to places that are not in your plan’s network, you are potentially on the hook for an unlimited amount of the bill," said Dr. Mark Fendrick, a professor of medicine and health management and policy at the University of Michigan.

A joint statement from Memorial Sloan and Anthem released late Monday afternoon said the "organizations have reached a new multiyear agreement providing Anthem members with continued access to care at MSK."

In an email, Memorial Sloan declined to release specific details of the contract "due to confidentiality agreements."

Finn said the possibility of looking for new doctors caused her stress.

"I was in a panic," said Finn, who had a tumor removed in May 2020 but still uses Memorial Sloan for annual visits, mammograms and sonograms.

On Friday, Memorial Sloan’s chair of surgery, Dr. Jeffrey Drebin, had argued in a statement that "Anthem has underpaid MSK for years." He called it "an unsustainable situation."

Anthem did not respond to requests for comment on Drebin’s statement.

"MSK has an obligation to ensure reimbursement rates allow us to continue delivering the best outcomes and the most cost-effective cancer care in the region," Dr. Selwyn M. Vickers, Memorial Sloan’s president and CEO, said in a statement Monday.

Although the in-network arrangement was scheduled to expire Jan. 1, Anthem members would have had in-network coverage until at least March 1 even in the absence of an agreement, because of a state-required "cooling-off period," state Health Department spokeswoman Cadence Acquaviva said in a statement.

As Memorial Sloan and Anthem reached an agreement, the Mount Sinai Health System and Cigna Healthcare continue negotiations, Mount Sinai and Cigna said in separate statements Monday. Their contract expires Jan. 31.

"We are hopeful we will come to a resolution that does not disrupt patient care," Mount Sinai said.

Fendrick said disputes between insurers and health care providers have become more common in recent years.

"The real issue is the cost of care and the prices of care," he said, pointing to a report published Wednesday in the journal Health Affairs that found U.S. health care spending rose 7.5% in 2023, to $4.9 trillion.

The insurer and the health care provider each has leverage over the other in negotiations, and an incentive to come to an agreement, Fendrick said.

"The leverage for the provider is if people aren’t in your network, people will go to another plan," he said.

The sway that insurers have is: "We’re not going to send any of our patients your way," he said.

By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.