PDF(Pubmed)
Abstract：
UNASSIGNED: Insurance barriers to cancer care can cause significant patient and clinician burden.
UNASSIGNED: To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment.
UNASSIGNED: 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.
UNASSIGNED: Insurance denial for RT.
UNASSIGNED: Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment.
UNASSIGNED: 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.
UNASSIGNED: Insurance denial for RT.
UNASSIGNED: Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests.
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
■癌症护理的保险障碍可能会导致患者和临床医生的巨大负担。
■为了调查保险否认与技术变化的关联，剂量,和放射肿瘤治疗的时间。
■在这个单机构队列分析中，数据收集自2021年11月1日至2022年12月8日接受放疗(RT)的患者的数据.数据从2022年12月15日至2023年12月31日进行了分析。
■RT拒绝保险。
■这些否认与RT技术的变化有关，剂量,使用χ2检验评估治疗分娩时间。
■共206例（118名女性[57.3%]；中位年龄，58[范围，26-91]年）被确定。大多数保险公司(199[96.6%])是商业付款人，7（3.4%）是医疗保险或医疗保险优势。161名患者（78.2％）小于65岁。206例,最终获得批准的127（61.7％）没有对所要求的RT技术或处方剂量进行任何更改；修改RT技术和/或付款人要求的处方剂量后获得批准的56（27.2％）。在21例需要改变处方剂量的病例中，剂量减少的中位数为24.0（范围，2.3-51.0）Gy。在接受RT的202例（98.1%）中，72（34.9％）延迟，平均（SD）为7.8（9.1）天，中位数为5（范围，1-49）天。4例(1.9%)最终没有获得任何授权,有3人(1.5%)没有接受RT，1人(0.5%)在另一机构寻求治疗。
■在这项针对付款人否认病例的队列研究中，放射肿瘤学中的大多数保险否认最终在上诉中获得批准；然而，RT技术和/或有效性可能会受到付款人强制变更的影响。需要进一步的调查和行动，以认识到由RT的保险拒绝引起的临床医生的时间和经济负担以及对患者的临床影响。
■为了调查保险否认与技术变化的关联，剂量,和放射肿瘤治疗的时间。
■在这个单机构队列分析中，数据收集自2021年11月1日至2022年12月8日接受放疗(RT)的患者的数据.数据从2022年12月15日至2023年12月31日进行了分析。
■RT拒绝保险。
■这些否认与RT技术的变化有关，剂量,使用χ2检验评估治疗分娩时间。
■共206例（118名女性[57.3%]；中位年龄，58[范围，26-91]年）被确定。大多数保险公司(199[96.6%])是商业付款人，7（3.4%）是医疗保险或医疗保险优势。161名患者（78.2％）小于65岁。206例,最终获得批准的127（61.7％）没有对所要求的RT技术或处方剂量进行任何更改；修改RT技术和/或付款人要求的处方剂量后获得批准的56（27.2％）。在21例需要改变处方剂量的病例中，剂量减少的中位数为24.0（范围，2.3-51.0）Gy。在接受RT的202例（98.1%）中，72（34.9％）延迟，平均（SD）为7.8（9.1）天，中位数为5（范围，1-49）天。4例(1.9%)最终没有获得任何授权,有3人(1.5%)没有接受RT，1人(0.5%)在另一机构寻求治疗。
■在这项针对付款人否认病例的队列研究中，放射肿瘤学中的大多数保险否认最终在上诉中获得批准；然而，RT技术和/或有效性可能会受到付款人强制变更的影响。需要进一步的调查和行动，以认识到由RT的保险拒绝引起的临床医生的时间和经济负担以及对患者的临床影响。
