Policy coverage change pleases patient

Insurance payments for routine care for those in cancer clinical trials had been at issue.

Sandi Harris, who is fighting ovarian cancer, is both pleased and surprised to hear CommunityCare of Oklahoma has changed its policy regarding patients who participate in clinical trials.
“I am in a position where I’m having to continue treatment and search for drugs and chemotherapy that will get control of the cancer,” she said.

CommunityCare is the second largest group health insurer in the state.

Recently, Harris told the Tulsa World how the health insurer denied coverage of routine medical care if she participated in a clinical trial. She had no idea the insurer modified its policy Jan. 1.

“I haven’t received a new member handbook. It would be common courtesy to those people with cancer to notify them of that,” she said.

When asked about the company’s policy for the previous story, CommunityCare CEO Richard Todd only commented by e-mail that his company covered routine medical care for patients in clinical trials and that was included in a Tulsa World article published May 18.

The Tulsa World also published a 2009 CommunityCare policy that said the insurer did not cover routine medical expenses for those patients.

In a second e-mailed reply, Todd again failed to explain that the policy had been changed. The Oklahoma Insurance Department has confirmed a new policy was approved in October and took effect Jan. 1.

In seeking a new face-to-face interview with Todd after the May 18 story, the Tulsa World submitted a set of written questions
that were not answered directly.

CommunityCare did issue a written statement Wednesday claiming that the May 18 story was “incorrect.” CommunityCare’s statement said: “The policy change was approved by the Department of Insurance in 2009, and that information is reflected in 2010 member materials. In fact, today there are multiple members who are participating in clinical trials for whom CommunityCare is covering the routine costs of services that are considered ‘standard of care’ for their conditions.”

As of May 14, member handbooks associated with numerous Cancer Care patients reflected no change to the clinical trial policy, said Dr. Daron Street, a gynecological oncologist and researcher with Cancer Care Associates.

“No one was aware of the change in their policy. I haven’t seen it,” he said. “I am pleased they made changes. It’s in the patients’ best interest.”

As of June 4, at least 22 Cancer Care patients remained linked to the 2009 member handbook. But 14 had been updated to the 2010 handbook, possibly because plan years differ among employer groups, Cancer Care Associates’ Chief Executive Officer Paul W. Bukofzer said.

On the CommunityCare website, the new clinical trials policy was not listed on the company’s “comparison of benefit wording changes” from 2009 to 2010.

Since May 18, Todd has refused repeated requests to discuss how CommunityCare has communicated its new policy to its members.

“We applaud that they are now covering clinical trials, but we didn’t readily have that information,” said Cancer Care’s Bukofzer. “We have to rely on some written information so we can get paid for our services.”

He said CommunityCare has agreed to work with Cancer Care to improve communications between the two entities.

“Provider contracts are negotiated every two or three years. Within that three-year period, we don’t have much dialogue,” Bukofzer said.

Oklahoma law doesn’t require insurers to cover a patient’s routine care once they are accepted into a clinical trial.

But 29 states and the District of Columbia have passed legislation or have special agreements that do, including neighboring states such as Missouri, Louisiana, Colorado and Texas, the National Cancer Institute says.

Blue Cross and Blue Shield of Oklahoma, the largest group health insurer in the state, has covered routine medical care for patients in clinical trials for a number of years. The company also lists its active and pending policies on its website.

Harris is looking to experimental drugs because traditional treatment isn’t working.

“I can’t do the study I had wanted to do. That opportunity is gone, but that doesn’t mean there won’t be more opportunities.

“Obviously I’m pleased if this does, in fact, allow me to participate in clinical trials,” Harris said. “It’s kind of a last chance.”

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