Insurance denials and patient treatment in a large academic radiation oncology center Journal Article
| Authors: | Shin, J. Y.; Chino, F.; Cuaron, J. J.; Washington, C.; Jablonowski, M.; McBride, S.; Gomez, D. R. |
| Article Title: | Insurance denials and patient treatment in a large academic radiation oncology center |
| Abstract: | Importance: Insurance barriers to cancer care can cause significant patient and clinician burden. Objective: To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment. Design, Setting, and Participants: In this single-institution cohort analysis, data were collected from patients with payer-denied authorization for radiation therapy (RT) from November 1, 2021, to December 8, 2022. Data were analyzed from December 15, 2022, to December 31, 2023. Exposure: Insurance denial for RT. Main Outcomes and Measures: Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2tests. Results: A total of 206 cases (118 women [57.3%]; median age, 58 [range, 26-91] years) were identified. Most insurers (199 [96.6%]) were commercial payers, while 7 (3.4%) were Medicare or Medicare Advantage. One hundred sixty-one patients (78.2%) were younger than 65 years. Of 206 cases, 127 (61.7%) were ultimately authorized without any change to the requested RT technique or prescription dose; 56 (27.2%) were authorized after modification to RT technique and/or prescription dose required by the payer. Of 21 cases with required prescription dose change, the median decrease in dose was 24.0 (range, 2.3-51.0) Gy. Of 202 cases (98.1%) with RT delivered, 72 (34.9%) were delayed for a mean (SD) of 7.8 (9.1) days and median of 5 (range, 1-49) days. Four cases (1.9%) ultimately did not receive any authorization, with 3 (1.5%) not undergoing RT, and 1 (0.5%) seeking treatment at another institution. Conclusions and Relevance: In this cohort study of patients with payer-denied cases, most insurance denials in radiation oncology were ultimately approved on appeal; however, RT technique and/or effectiveness may be compromised by payer-mandated changes. Further investigation and action to recognize the time and financial burdens on clinicians and clinical effects on patients caused by insurance denials of RT is needed.. © 2024 American Medical Association. All rights reserved. |
| Keywords: | adult; controlled study; aged; aged, 80 and over; middle aged; major clinical study; united states; neoplasm; neoplasms; cohort studies; radiotherapy; cohort analysis; health insurance; prescription; economics; radiation oncology; therapy delay; university hospital; insurance, health; academic medical centers; time to treatment; very elderly; humans; human; male; female; article; prior authorization; insurance denial |
| Journal Title: | JAMA Network Open |
| Volume: | 7 |
| Issue: | 6 |
| ISSN: | 2574-3805 |
| Publisher: | American Medical Association |
| Date Published: | 2024-06-01 |
| Start Page: | e2416359 |
| Language: | English |
| DOI: | 10.1001/jamanetworkopen.2024.16359 |
| PUBMED: | 38865128 |
| PROVIDER: | scopus |
| PMCID: | PMC11170304 |
| DOI/URL: | |
| Notes: | Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- MSK corresponding author is Jacob Shin -- Source: Scopus |
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