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Cancer patient surprised by Anthem's notice that UCHealth no longer 'in network' on low premium plan

UCHealth still part of Anthem's other plans
Posted at 4:03 AM, Nov 30, 2020
and last updated 2020-11-30 07:55:46-05

DENVER — A major change to a health insurance plan is the last thing most people want in the middle of a pandemic, especially if they have cancer.

Johnathon Jansen, 31, of Denver, was first diagnosed with Stage 4 cancer on Dec. 5, 2017.

He had been living briefly in New Jersey.

"I woke up to my normal morning routine and out of nowhere doubled over in pain," he said.

His doctor sent him to a radiologist, who asked if he'd been exposed to radiation or chemicals.

"I'm like, 'Nope, not that I'm aware of,'" he said.

The radiologist then pointed to a scan showing a mass near his duodenum. The cancer has since metastasized to his liver.

He said when he and his fiancee moved back to Colorado, it was critical that he find a doctor who could treat this form of cancer.

He found one at UCHealth. She specializes in treating GIST or gastrointestinal stromal tumors, which are normally found in the stomach or small intestine.

"Traditional chemo doesn't work on this," Jansen said. "I take pills called TKI inhibitors, which turn off the growth receptors on the cell in a couple of different locations."

The day before Thanksgiving, Jansen received a call from Anthem.

"They said they we're going to lower my premium, but would no longer be covering UCHealth," he said.

That's when panic set it.

"It was a heart-stopper, nerve wracking," he said. "I didn't sleep last night, wondering if I'm going to be able to keep my doctors or not."

Jansen said he tried to get answers on his own, but Anthem was no help.

He said the woman who called mentioned "continuation of care," but when he asked to be transferred to someone who could help him with the application, he was transferred to a general queue and that after waiting for a half hour, he finally got somebody who had no idea who he was, or why he was calling.

"I had to go through everything again and at the end of the day I got frustrated enough where I asked to speak to a manager and got put on hold. At about 5:15 p.m., the call just drops," he said. "I tried to call a couple of times yesterday and couldn't get through."

That's when he reached out to Denver7.

We called UCHealth. The Vice President of Communications Dan Weaver said they're working with many patients to help them receive an exception to the network change. He offered to help Jansen get through the application process.

"It's still up to the insurance company to approve or deny the request, but we've been happy to see that many patients have had their request approved," Weaver said.

Denver7 also reached out to Anthem.

Tony Felts, Anthem's senior director of communications, said "Anthem Blue Cross and Blue Shield is constantly exploring ways to make healthcare more affordable because we know that is the number one issue for Colorado consumers."

He said that's why Anthem introduced the Pathway Essentials network for 2021 for those living in the Denver metro area.

"It's a new benefit plan for individuals seeking a lower premium who are comfortable choosing from a more tailored network of healthcare providers," he said.

Felts added that UCHealth was invited to participate in the Pathway Essentials network, but chose not to.

He said UCHealth remains contracted and "in-network" for all other Anthem plans.

"Anthem members enrolled in Pathway Essentials who are currently receiving care from a UCHealth provider can call the customer service number on their Anthem ID card to see if they may continue to receive medical care from UCHealth," he said.

Jansen's fiancee Zoe Pielsticker said it is stressful not knowing if he will be able to continue getting treatment at UCHealth.

"It's not healthy," she said.

Pielsticker said the TKI inhibitors her fiance uses to shrink the tumors are very expensive, that his annual medication bill runs about $100,000.

She added that out-of-network expenses would compound the stress they're both under and would affect other life choices.

"Should the cancer take him, he would leave me with an insurmountable amount of medical debt, as his spouse. So it affects you in more ways that just his immediate medical care," she said.

Jansen said he's grateful Denver7 reached out to UCHealth.

"You guys being able to contact them and have them say they're going to call me to help set that up, that alone is above and beyond where I was before yesterday," he said.

Weaver said UCHealth understands Anthem's change in its "individual market plan" is difficult for many patients.

"We were not notified until this fall that the insurance carrier was removing our facilities from its exchange plan, which is why we won’t have an alternative plan ready for the exchange by Jan. 1," he said.

He said they are working as quickly as possible to explore options with other insurance carriers to create a plan that includes UCHealth and University of Colorado School of Medicine locations and providers.

"We hope that a new plan will be available with an insurance carrier on the exchange later in 2021 that will include UCHealth in its network."

He reiterated that this only applies to the "individual" plans offered on the exchange in metro Denver.

"We are still in-network for a large number of small and large group plans in metro Denver, and our locations are still in-network for individual plans offered on the exchange in northern and southern Colorado," he said.