Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Physician Billing Department, Memorial Sloan Kettering Cancer Center, New York, New York.
JAMA Netw Open. 2024 Jun 3;7(6):e2416359. doi: 10.1001/jamanetworkopen.2024.16359.
Insurance barriers to cancer care can cause significant patient and clinician burden.
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.
Insurance denial for RT.
Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests.
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.
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.
癌症治疗的保险障碍会给患者和临床医生带来重大负担。
研究保险拒付与放射肿瘤治疗的技术、剂量和治疗交付时间变化的关系。
设计、地点和参与者：在这项单机构队列分析中，数据来自于 2021 年 11 月 1 日至 2022 年 12 月 8 日因放射治疗（RT）支付方拒绝授权的患者。数据分析于 2022 年 12 月 15 日至 2023 年 12 月 31 日进行。
RT 的保险拒付。
使用 χ2 检验评估这些拒付与 RT 技术、剂量和治疗交付时间变化之间的关系。
共确定了 206 例病例（118 例女性[57.3%]；中位年龄 58[范围，26-91]岁）。大多数保险公司（199[96.6%]）为商业支付方，而 7 家（3.4%）为医疗保险或医疗保险优势计划。161 例患者（78.2%）年龄小于 65 岁。在 206 例病例中，127 例（61.7%）最终在不改变请求的 RT 技术或处方剂量的情况下获得授权；56 例（27.2%）在支付方要求的 RT 技术和/或处方剂量修改后获得授权。在 21 例需要修改处方剂量的情况下，中位剂量降低 24.0（范围，2.3-51.0）Gy。在 202 例（98.1%）接受 RT 治疗的病例中，72 例（34.9%）延迟治疗，平均（SD）延迟 7.8（9.1）天，中位数为 5（范围，1-49）天。有 4 例（1.9%）最终未获得任何授权，其中 3 例（1.5%）未接受 RT，1 例（0.5%）在另一家机构接受治疗。
在这项针对有支付方拒赔病例的患者队列研究中，放射肿瘤学中的大多数保险拒赔最终在上诉中获得批准；然而，RT 技术和/或效果可能因支付方规定的变化而受到影响。需要进一步调查和采取行动，以认识到保险拒付 RT 给临床医生带来的时间和财务负担，以及对患者的临床影响。
Zotero 插件
