Cancer Benefits to Look for in a Health Plan

WASHINGTON—The American Federation of Clinical Oncologic Societies (AFCOS) has developed a 15-item list of basic standards for consumers to consider in selecting a health insurance plan. The aim is to ensure that patients will obtain high-quality cancer care, should they need it. AFCOS, a coalition of nine professional medical societies, released the list at a Capitol Hill briefing sponsored by Rep. Sue Kelly (R-NY) and Rep. Anna Eshoo (D-CA).

According to AFCOS, consumers should look for the following benefits when choosing a health plan:

1. Access to appropriate cancer specialists, including facilities outside the payer’s network if medically necessary services are not available within the plan.

2. Access to appropriate and culturally sensitive information, participation in decision-making, and full informed consent.

3. Timely access to high-quality cancer screening and other diagnostic tests. When tests fail to conclusively establish or negate a cancer diagnosis, patients must have direct access to a cancer specialist for further evaluation.

4. Upon diagnosis of cancer, timely referral for cancer treatment.

5. Cancer care delivery that is planned and coordinated by a multidisciplinary team of oncologic professionals.

6. Ready access to pediatric oncologists for treatment and evaluation of childhood cancers.

7. Plans that allow cancer specialists to serve as the primary care physician when delivering active cancer therapy.

8. Access to and coverage of medically appropriate, state-of-the-art cancer treatment, including unlabeled indications of drugs and biologics used in chemotherapy regimens if listed in the compendia or supported in peer-reviewed medical literature; access to high-quality radiation therapy; access to surgical subspecialty care, including specialized techniques when medically indicated; and recognition that specialized oncology nursing care and social work are an essential part of multidisciplinary cancer care.

9. Access to and coverage of patient care costs associated with participating in cancer clinical trials that have been approved by the National Institutes of Health, NIH cooperative groups and centers, the FDA, the Department of Defense, the Department of Veterans Affairs, or a qualified nongovernmental research entity identified in the guidelines issued by the NIH for cancer center support grants.

10. Access to psychosocial services, including support groups, counseling by oncology social workers and other trained psychosocial professionals, and medical interventions.

11. Access to supportive care services and effective symptom management.

12. Access to and coverage for hospice services.

13. Access to comprehensive rehabilitation, including reconstruction, prosthetic devices, and durable and disposable medical devices.

14. Access to long-term follow-up by a cancer specialist.

15. Access to coverage regardless of pre-existing conditions, genetics, or other risk factors.