Cancer patient feels "like collateral damage" after MGB Health Plan removes Dana-Farber from Medicare Advantage network

By Amanda Callahan, WBZ-TV

The Mass General Brigham Health Plan is removing Dana-Farber Cancer Institute from its Medicare Advantage network. Hundreds of patients are now facing tough decisions about their care.

Eldon Clingan was diagnosed with prostate cancer in 1999. He's been receiving treatment at Dana-Farber, seeing the same oncologist for over 20 years. But last month he received a letter saying his treatment at the cancer institute won't be covered by his insurance.

"It adds to the anxiety and worry, which you know, at age 88 with cancer, you really do not need that kind of stress in your life," Clingan told WBZ-TV. 

Starting Oct. 1, Mass General Brigham Health Plan's Medicare Advantage provider network will no longer include Dana-Farber, impacting Clingan and about 1,000 other patients.

"Are they going to cover my medication, for example? This is very expensive medication," Clingan said.

MGB Health Plan, which operates separately from the MGB hospital system, says the change in coverage is "due to the challenging environment impacting Medicare Advantage plans nationwide."

Impacted patients can continue to receive the same care throughout a 90-day transition period, but after the first of the new year, if they want to stay at Dana-Farber, they will need a new insurance plan.

For Clingan, that's an easy decision, but the question is at what cost? "I have had excellent care from my Dana-Farber doctor for 23 years and I want to stay with her," Clingan said. "I want to stay with the medication that she has prescribed. I don't know for certain how I can do that."

The move by the MGB insurance company comes after Dana-Farber decided to end its long-term partnership with the MGB hospital system in 2028. MGB maintains the insurance change is "unrelated to the ongoing clinical separation and realignment among cancer providers in Boston."

But Clingan sees it differently. "I feel like I am collateral damage in this war," Clingan said. "Sick people should not have to suffer this kind of stress in addition to the stress of cancer, which for most of us, one way or the other, is going to be fatal."

Coverage can be extended past the 90-day transition period depending on the patient, for example, if someone is part of an ongoing clinical trial or if they are undergoing radiation or chemotherapy.