Some of America’s best cancer hospitals are off-limits to many of the people now signing up for coverage under the nation’s new health care program.

Doctors and administrators say they’re concerned. So are some state insurance regulators. An Associated Press survey found examples coast to coast.

Seattle Cancer Care Alliance is excluded by five out of eight insurers in Washington’s insurance exchange. MD Anderson Cancer Center says it’s in less than half of the plans in the Houston area. Memorial Sloan-Kettering is included by two of nine insurers in New York City and has out-of-network agreements with two more.

In all, only four of 19 nationally recognized comprehensive cancer centers that responded to AP’s survey said patients have access through all the insurance companies in their states’ exchanges.

Those patients may not be able to get the most advanced treatment, including clinical trials of new medications. Also, it’s not easy for consumers to tell if top-level institutions are included in a plan.

“The challenges of this are going to become evident … as cancer cases start to arrive,” said Norman Hubbard, executive vice president of Seattle Cancer Care Alliance.

Before President Barack Obama’s health care law, a cancer diagnosis could make you uninsurable. Now, insurers can’t turn away people with health problems or charge them more. Lifetime dollar limits on policies, once a financial trap-door for cancer patients, are also banned. The new obstacles are more subtle.

To keep premiums low, insurers have designed narrow networks of hospitals and doctors. The government-subsidized private plans on the exchanges typically offer less choice than Medicare or employer plans. By not including a top cancer center an insurer can cut costs.

The AP surveyed 23 institutions around the country that are part of the National Comprehensive Cancer Network. AP asked the centers how many insurance companies in their state’s exchange included them as a network provider. Of the 19 that responded, four reported access through all insurers.

Anthem Blue Cross and Blue Shield officials said its network was based on research involving thousands of consumers and businesses.

“What we learned was that people are willing to make trade-offs in order to have access to affordable health care,” the company said. “Our provider networks reflect this.”

The Obama administration says it has notified insurers that their networks will get closer scrutiny for next year in the 36 states served by the federal exchange. Cancer care will be a priority, it says.

Written by Ricardo Alonso-Zaldivar, AP for NBC News March 19, 2014.

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