A network split is forcing some cancer patients in Boston to choose between their doctor and their insurance coverage. A network, in plain terms, is the list of hospitals and specialists an insurer has agreed to pay for directly. Starting October 1, the insurance arm of Mass General Brigham will no longer include Dana-Farber Cancer Institute among its covered providers under its Medicare Advantage plan.
The plan covers roughly 20,500 members. Most are not currently receiving cancer care at Dana-Farber. Only a fraction of the membership is getting cancer treatment there at any given time, which means the practical disruption lands on a smaller group inside a large plan.
For that smaller group, the choice is not abstract. Eldon Clingan is 88 years old, a retired accountant, and has been treated by the same cancer specialist at Dana-Farber for more than two decades. He said he trusts her and credits her with saving his life. After October 1, he will need to either find a new oncologist his current plan covers, or switch to a plan that still covers Dana-Farber.
What Medicare Advantage is, and why this type of change happens
Medicare Advantage is private insurance that takes the place of standard government Medicare coverage. Insurers that sell these plans build their own networks of covered providers, and those networks can change. When a hospital and an insurer cannot reach a contract agreement, the hospital can fall off the plan's covered list.
Mass General Brigham, a large Boston-area hospital system, operates its own insurance arm. That arm is the entity removing Dana-Farber Cancer Institute from its covered network. Clingan has been with the same physician at Dana-Farber for more than two decades. He is 88 years old. October 1 is weeks away.