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Thousands to lose insurance plans, access to top hospitals

HARRIS COUNTY, Texas – In January, thousands of Harris County residents will lose their insurance plans and access to some of Houston's best hospitals.

This week, Humana Insurance appeared to swoop in and offer a saving grace, but it’s unclear if that’s a real solution. MD Anderson said it has not made an agreement with Humana yet.

"Everybody is saying, 'I want to have access to MD Anderson and all their latest medicine.' It’s like, you have to pay for that!" said Vivian Ho, James A. Baker III Institute Chair in Health Economics.

It's a touchy subject for 2,300 cancer patients who are losing access to their doctors at MD Anderson. Major insurance providers dropped the individual PPO option, coverage many purchased through the health care marketplace.

Now those patients will be forced to switch doctors, switch plans and start over.

"It's very unfortunate that there are these other people who are caught in the cross-hairs and can't get access to a PPO plan," Ho said.

One of those caught in the cross-hairs is Renee Mathew.

"It's wrong, it's really wrong," Mathew said.

Mathew's sister and mother both died of breast cancer. She regularly gets biopsies at MD Anderson and participates in clinical research trials, which can sometimes be covered by insurance.

"I've been in clinical trials where they've done biopsies, fine needle biopsies, breast biopsies, core biopsies, painful things," she said. "All to make a contribution to curing cancer."

In January, she says she won't be a part of it anymore. Patients like her are losing coverage and access to most of Houston's big-name hospitals, including MD Anderson and Texas Children's, depending on their provider.

This week, Humana came up with a high-deductible plan that's off the exchange, though it has not confirmed which facilities this covers. In an email to Channel 2, Humana said:

"Humana will offer an off-exchange individual PPO product for consumers in Harris County. The product is a high-deductible health plan and will feature ChoiceCare Network, one of the largest healthcare provider networks in the United States and a Humana subsidiary.  This plan covers inpatient and outpatient medical services, and includes prescription drug coverage.

This is an off-exchange offering.

The name of the network of doctors, hospitals and other health care providers is "ChoiceCare." The plan is offered by Humana Insurance Company.

This plan will be available on our quoting and enrollment tools on December 18. We're working on a process that would allow individuals to enroll so that their plan begins January 1."

Ho said purchasing outside of the marketplace will be pricey.

"Who are they going to attract? They're going to attract all patients who have already been diagnosed with cancer. These are all very high-cost patients. They're probably going to exceed their market maximum and so they're going to be very expensive for the company," Ho said.

She said this is why insurance companies dropped the PPO in the first place. They are losing money by covering people who never saw doctors before the Affordable Care Act. At the same time, Ho said hospitals are simply asking for too much money.

"I must also say it's a very deluxe facility. If you've ever walked through it, some of what you're paying for...is a very, very nice environment. It's not clear that translates to better outcomes and I think you can actually, in many types of cancer, get the same outcome at a lower cost at other very good providers in the Houston area," Ho said.

HMO plans can still be purchased through the marketplace and off-exchange plans like the new Humana PPO can buy coverage with doctors like those at Oncology Consultants in Memorial.

Oncology Consultants confirmed to Channel 2 they are accepting Humana’s PPO.

"We were in the PPO, but now the PPO is being dissolved, but we are also in the HMO exchanges. So the patient still has access to quality cancer care," said Katherine Grigsby.

Grigsby said they're already helping people make the switch. She mentioned one patient in particular who she is working with, "We are making sure he never misses a beat in his chemotherapy. We are going to be scheduling him on the next day."

"We have nurse navigators that will be helping him, we have financial advisers, similar to the big facilities in the medical center," Grigsby said.

Ho says in order for the individual PPO plans to make a comeback, companies will need to attract young, healthy patients to even the cost of people exceeding their deductibles.