Marla Puccetti spent all day Monday on the phone, urgently trying to reach someone at her health insurance company and the hospital that’s treating her cancer.
“I’ve been on hold all day long, basically,” said Puccetti, 53, who co-owns a restaurant with her partner in Narrowsburg, New York.
Her health insurer, UnitedHealthcare, and her hospital, Memorial Sloan Kettering Cancer Center, have been locked in a contract dispute that wasn’t resolved by the overnight deadline.
That means Puccetti and roughly 19,000 other cancer patients insured by UnitedHealthcare who are receiving treatment at Memorial Sloan Kettering are no longer in-network at the cancer center, it announced. They may face higher bills for their cancer treatment starting Tuesday.
Puccetti doesn’t have out-of-network coverage on her current plan, so she would have to pay the full cost of her care,which she can’t afford. But going anywhere but MSK for her treatment is unthinkable.
“It’s terrifying. I don’t want to go anywhere else,” she said. “All of my doctors are there. All of my surgeons are there. I feel like they saved my life.”
The insurer and the cancer center, which has locations in New York City, New York state and New Jersey, had been in tense contract negotiations over rate increases that MSK said it needed to keep up with the cost of care.
UnitedHealthcare said MSK asked for a 30% increase in payments for its facilities and physicians, as well as a 36% increase for its cancer center. The insurer said the increases would drive up costs for consumers by $405 million over the next two years.
“We will remain at the negotiating table as long as it takes to renew our relationship with MSK. We ask MSK to join us there and to reach an agreement people and employers can afford,” UnitedHealthcare CEO Junior Harewood said in a statement Monday.
United said it delivered proposals to MSK on June 23 and June 30, but the hospital has so far declined the offers.
The insurer says it already reimburses MSK at rates significantly higher than other systems specializing in cancer care in the region.
Dr. Cardinale Smith, chief medical officer for MSK, disputes the idea that their cancer center is driving up the cost of care for patients. She says their cost of care is actually 4% to 16% lower than at comparable hospitals in the area.
“Our patients are getting better outcomes for total lower cost of care,” Smith said.
UnitedHealthcare is the nation’s largest insurer, and she says hers isn’t the only system that’s being squeezed in contract negotiations with them.
“This is happening in other institutions as well, and it reflects what I think is a deeper tension in our health care system where there are financial priorities that are really being placed ahead of what’s best for patients,” Smith said.
In 2021, Puccetti was diagnosed with breast and then cervical cancer just a few weeks apart. After a mastectomy and a hysterectomy, her breast cancer is in remission, but her cervical cancer has been tougher to snuff out. It has returned three times. She has tallied 60 rounds of radiation and 100 rounds of chemotherapy and has lost her hair three times.
Her tumor is in a bad spot, she says, attached to both her bladder and her bowel. Doctors said they could remove it surgically, but it would leave her dependent on bags hanging outside her body to collect urine and stool for the rest of her life, a situation she found untenable.
Now, she’s on an immunotherapy drug that helps her body recognize and attack the cancer, with a goal of keeping it stable. She has been making the two-hour trip from her home in upstate New York to MSK about once a week for the past few months for tests to help doctors keep tabs on the tumor.
She got a letter just two weeks ago from UnitedHealthcare that said MSK might not be in her network starting July 1.
“It all came as a shock that this was actually happening,” she said.
On Monday, the two parties said they’d been unable to reach an agreement, leaving thousands of patients uncertain whether they’ll be able to afford to continue their care at MSK.
In a statement to CNN, UnitedHealthcare said patients who are in active on ongoing treatment with an MSK provider when they go out of network will automatically receive continuity of care, meaning their care will still be covered at in-network rates for at least 90 days after the change takes effect. The insurer said patients don’t need to apply for the extended benefits — they will be automatically granted.
Puccetti said she’s unsure what she’ll do. She’s been researching other coverage options. Her UnitedHealthcare plan costs $3,200 a month, she says. It does provide some coverage, but she still owes “thousands and thousands” in out-of-pocket costs.
Through it all, she’s worked full-time at the restaurant, cooking, tending bar, keeping the books.
She applied for financial aid through Memorial Sloan Kettering but hasn’t heard whether she qualifies.
Now, she says, she’ll have to find an alternative.
“Everyone kept saying, ‘well, don’t panic, because they’re going to come to a resolution.’ So I tried not to panic, but how can you not?” she said.