{Reference Type}: Journal Article
{Title}: Insurance Denials and Patient Treatment in a Large Academic Radiation Oncology Center.
{Author}: Shin JY;Chino F;Cuaron JJ;Washington C;Jablonowski M;McBride S;Gomez DR;
{Journal}: JAMA Netw Open
{Volume}: 7
{Issue}: 6
{Year}: 2024 Jun 3
{Factor}: 13.353
{DOI}: 10.1001/jamanetworkopen.2024.16359
{Abstract}: <B>UNASSIGNED: </B>Insurance barriers to cancer care can cause significant patient and clinician burden.<BR><B>UNASSIGNED: </B>To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>Insurance denial for RT.<BR><B>UNASSIGNED: </B>Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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.