Obstacles to Accessing Gynecologic Oncology Care With Insurance in the US

Anna Jo Bodurtha Smith, MD, MPH, MSc, fellow in Obstetrics and Gynecology at the University of Pennsylvania Perelman School of Medicine, discusses her research on issues facing patients who need care for gynecologic cancers who have private insurance in the United States.

Smith says that though screening tests for cancers are covered by insurance, it is not required to cover all costs related to gynecologic care such as follow-up after cervical cancer screenings and treatment for possible symptoms of gynecologic cancers.

For patients who are diagnosed with cancer, they may not be able to see the closest gynecologic oncologist to them due to in-network requirements, and Smith’s research has found that some plans have no specialized gynecologic oncologists in-network at all.

Private insurance plans also often cut costs by passing them to patients, including high copays for physician visits, procedures, and medications. Smith says that patients pay an average of $5000 in the first year of gynecologic cancer treatment despite having private insurance coverage. Additionally, insurance requirements such as prior authorization can create delays and barriers that keep patients from getting the care they need.

TRANSCRIPTION:

0:08 | One of the big issues at the start is whether or not—so the Affordable Care Act covers cervical cancer screening, but private insurance is not required to cover the cost of any follow-up. We know that the follow-up for abnormal cervical cancer screening can actually be quite costly for a lot of privately insured patients. Similarly, gynecologic visits are not always consistently covered and the care you may need for gynecologic symptoms, such as vaginal bleeding or bloating, which are symptoms of gynecologic cancer, those visits may have a high copay, limiting patients’ ability to get in for those early symptoms.

Then once you're diagnosed with gynecologic cancer with private insurance, we're seeing more and more plans that have narrower health care networks. So it may be that there is a gynecologic oncologist in your network but it's not the one closest to you. Your insurance wants to go see somebody far away or they may not be the provider that's local. There is some research that there have been insurance plans that have no gynecologic oncologist in the network. And so, you have to navigate “How do I get care for my cancer?” when insurance is saying there is nobody who can care for my cancer. That is getting into gynecologic oncology.

Then we know that private insurance plans have, understandably with the cost of care, tried to figure out how we can lower the cost of care. Unfortunately, a lot of the costs fall back on patients. You may experience during your cancer treatment with private insurance, you may experience both high cost of visits for follow-up and medications can be quite expensive. We know that patients with private insurance on average spend $5,000 in their first year of gynecologic cancer treatment, which is a lot of money. Then, we know that there [are] more things like prior authorization that can cause delays and put-up administrative barriers to patients getting the gynecologic cancer care they need with private insurance.