SCCA and the Affordable Care Act (ACA)
Seattle Cancer Care Alliance (SCCA) supports the goals of the Affordable Care Act (ACA) to make insurance coverage more secure for those who have insurance, to extend affordable coverage to the uninsured, and to improve health care quality and patient safety. In this state, thousands of individuals who do not have health insurance will be able to obtain it through the Washington Health Benefit Exchange. And for cancer patients, the ACA eliminates the challenge of lifetime maximums, ensures coverage for pre-existing conditions, and improves access to clinical trials.
Unfortunately, when it comes to accessing quality cancer care, many consumers seeking insurance through Washington Healthplanfinder will not have coverage for cancer treatment at SCCA. Because this may affect you and your family, we wanted to provide you with some information to help you navigate your care options.
Below is a summary of frequently asked questions regarding the Washington Healthcare Exchange. If you have any personal questions regarding your treatment options, we encourage you to contact your insurance company directly. Our Patient Financial Services team is also available Monday through Friday from 9 a.m. to 5 p.m. at 206-288-1113 to discuss options for receiving your care with us.
Which insurance plans on Washington Healthplanfinder include SCCA?
- SCCA is an in-network provider for the following health care plans: Community Health Plan of Washington, Group Health HMO*, and Kaiser HMO*.
*Specialist services are covered, pending permission to see a specialist
- SCCA is considered an out-of-network provider for the following health care plans: Bridgespan, Premera Heritage Signature, Lifewise Essentials (Lifewise Connect Network), Molina Marketplace, and Ambetter by Coordinated Care.
What do I do if I am told that my new insurance coverage does not cover my current treatment and care at SCCA?
If your new insurance coverage through Washington Heathplanfinder places SCCA as an out-of-network provider, this may affect your out-of-pocket costs for cancer care. Because each case is unique, it’s important to contact your insurance company to discuss your options. Additionally, our
Patient Financial Services team is available discuss options for continuing your care with us. Patient Financial Services is available Monday through Friday from 9 a.m. to 5 p.m. at 206-288-1113.
Can I still have treatment at SCCA?
We are committed to providing the best cancer care to all who come to us. However, your individual circumstances and benefits plan may change your coverage, increasing your out-of-pocket costs. To best understand how this change impacts you, we encourage you to contact your insurance company to discuss how your out-of-pocket costs might change.
Does this impact my SCCA treatment at Northwest Hospital/ SCCA at EvergreenHealth?
Changes to your insurance coverage may impact your out-of-pocket costs at these sites. To best understand how this change impacts you, we encourage you to contact your insurance company.
How can I be certain that my doctor is covered by my insurance while I am treated at SCCA?
The best way to understand your coverage is to contact your insurance company and ask them specifically about your doctor. SCCA Patient Financial Services is available to assist you in those conversations as needed.
What if I have already begun my treatment at the SCCA? The continuity of my care is important to me. Can someone help me advocate for coverage after my insurer has declined payment?
It is important to contact your insurance company early to fully understand any changes to your coverage. Each insurance plan has a different set of criteria regarding continuity of care.
Is there a state agency that is monitoring the implementation of the Washington Healthplanfinder and how do I contact them about my frustrations with the current system?
We encourage you to share your story about how your family or others are negatively impacted by insurance plans not including coverage at SCCA with the Office of the Insurance Commission. The office can be reached through their hotline at 1-800-562-6900 or by submitting a letter online at www.insurance.wa.gov/connect-with-us/ask-mike/index.html. Please also feel free to contact SCCA to discuss how to further share your story.
Will the new insurance company notify me of any changes to coverage? What recourse do I have when I find out my coverage has changed without being notified?
Your insurance company should contact you about any updates. When discussing any changes, it is important to know details concerning both your provider network as well as benefits plan. Use the following checklist as a guide when talking with your insurance company:
- What health care facilities and doctors are considered “in network”?
- What health care facilities and doctors are considered “out of network”?
- What are my out-of-pocket responsibilities for both in-network and out-of-network health care providers?
Who do I contact if I have additional questions?
We recommend that you first call the number on the back of your insurance card in order to understand directly from your insurance company what types of care they now cover. If you have concerns about how you can pay for your care or need any additional assistance, please call Patient Financial Services.
How do I contact SCCA Patient Financial Services with questions or concerns?
Patient Financial Services is available Monday through Friday from 9 a.m. to 5 p.m. at 206-288-1113.
Sharing Your Washington Healthcare Exchange Experience
We also encourage you to share your story with the Office of the Insurance Commission about how your family or others are impacted by insurance plans not including coverage for care at SCCA. The office can be reached through their hotline at 1-800-562-6900 or by submitting a letter online at www.insurance.wa.gov/connect-with-us/ask-mike/index.html. Please find the template below to help you voice your concerns to the Insurance Commissioner or feel free to contact SCCA to discuss how to further share your story.
SCCA suggests the following template for contacting the OIC regarding concerns about coverage for cancer services in the Insurance Exchange plans:
As a patient, I know first-hand how important the decision is for where I receive my treatment. National studies have shown that patients who begin their treatment at a top regional cancer center such as Seattle Cancer Care Alliance have better survival rates than those who started treatment elsewhere.
With SCCA excluded as an in-network provider in most of the plans sold on Washington Healthplanfinder, I am concerned about my access to care and the care of other cancer patients across the state.
The new narrow networks created have the potential to negatively impact my care and I urge the Commissioner to reexamine Washington Healthplanfinder regulations to require a comprehensive cancer center in all plans.