WASHINGTONThe American Federation of Clinical Oncologic
Societies (AFCOS) has developed a 15-item list of basic standards for
consumers to consider in selecting a health insurance plan. The aim
is to ensure that patients will obtain high-quality cancer care,
should they need it. AFCOS, a coalition of nine professional medical
societies, released the list at a Capitol Hill briefing sponsored by
Rep. Sue Kelly (R-NY) and Rep. Anna Eshoo (D-CA).
According to AFCOS, consumers should look for the following benefits
when choosing a health plan:
1. Access to appropriate cancer specialists, including facilities
outside the payers network if medically necessary services are
not available within the plan.
2. Access to appropriate and culturally sensitive information,
participation in decision-making, and full informed consent.
3. Timely access to high-quality cancer screening and other
diagnostic tests. When tests fail to conclusively establish or negate
a cancer diagnosis, patients must have direct access to a cancer
specialist for further evaluation.
4. Upon diagnosis of cancer, timely referral for cancer treatment.
5. Cancer care delivery that is planned and coordinated by a
multidisciplinary team of oncologic professionals.
6. Ready access to pediatric oncologists for treatment and evaluation
of childhood cancers.
7. Plans that allow cancer specialists to serve as the primary care
physician when delivering active cancer therapy.
8. Access to and coverage of medically appropriate, state-of-the-art
cancer treatment, including unlabeled indications of drugs and
biologics used in chemotherapy regimens if listed in the compendia or
supported in peer-reviewed medical literature; access to high-quality
radiation therapy; access to surgical subspecialty care, including
specialized techniques when medically indicated; and recognition that
specialized oncology nursing care and social work are an essential
part of multidisciplinary cancer care.
9. Access to and coverage of patient care costs associated with
participating in cancer clinical trials that have been approved by
the National Institutes of Health, NIH cooperative groups and
centers, the FDA, the Department of Defense, the Department of
Veterans Affairs, or a qualified nongovernmental research entity
identified in the guidelines issued by the NIH for cancer center
10. Access to psychosocial services, including support groups,
counseling by oncology social workers and other trained psychosocial
professionals, and medical interventions.
11. Access to supportive care services and effective symptom management.
12. Access to and coverage for hospice services.
13. Access to comprehensive rehabilitation, including reconstruction,
prosthetic devices, and durable and disposable medical devices.
14. Access to long-term follow-up by a cancer specialist.
15. Access to coverage regardless of pre-existing conditions,
genetics, or other risk factors.