DOTmed Home MRI Oncology Ultrasound Molecular Imaging X-Ray Cardiology Health IT Business Affairs
News Home Parts & Service Operating Room CT Women's Health Proton Therapy Endoscopy HTMs Mobile Imaging
Current Location:
> This Story

Log in or Register to rate this News Story
Forward Printable StoryPrint Comment


Oncology Homepage

Court rejects Varian’s final appeal over French hospital’s purchase of Accuray device Final verdict in a case involving multiple motions and appeals

New machine learning tool identifies breast lesions likely to become cancerous May help reduce unnecessary surgical procedures

Bracco Imaging acquires SurgVision Enables development of a real-time fluorescence image-guided surgery platform

Edgardo Baracchini INmune Bio appoints new board of directors member

Sectra report addresses value of machine learning in radiology Concept of automatic characterization and scoring of lesions has great support

Philips scores FDA clearance for small parts ultrasound imaging solution Available for EPIQ 7 and 5 and Affiniti 70 systems

Blue Earth Diagnostics inks Axumin deal with Seibersdorf Laboratories Manufacturing and distribution in certain European countries

Two new imaging agents may help physicians make better and quicker treatment decisions Could determine therapy response in 24 hours

Elekta partners with Alliance for Cancer Care The Alliance will replace all radiotherapy tools and services with Elekta products

European surgeons perform world's first super-microsurgery with robotic device Sutured .3 to .8 mm vessels

Gap between insurance policy language
and final decisions

Study finds majority of insurance denials overturned in pediatric proton patients

by Lauren Dubinsky , Senior Reporter
New research from Penn Medicine revealed that even though one in 10 pediatric cancer patients are initially denied coverage for proton therapy, nearly all ultimately receive approval.

“Because of the different way it moves within the body, proton radiotherapy can often spare normal tissues better than photon radiotherapy,” Dr. Eric Ojerholm, co-author of the study and radiation oncology instructor at Penn, told HCB News. “Cured pediatric patients are likely to live for a long time and be at risk for late toxicities from radiation, and pediatric developing normal tissues are more sensitive to effects from radiation than are adult tissues.”

Story Continues Below Advertisement

CT, MRI, NM, SPECT/CT, PET & PET/CT service, refurbished systems and parts

Accelerate your ROI with our Black Diamond Certified refurbished systems. One year warranty - ISO 13485 Certified - FDA registered - Over 65k parts in inventory DOTmed Certified

For the study, Ojerholm and his team evaluated five years' worth of insurance coverage data at Penn’s Roberts Proton Therapy Center, from 2010 to 2015. Out of the 287 cases, 89 percent were approved outright and 11 percent were initially denied.

After appeals were made, 97 percent of the denied cases were overturned and approved. However, a great deal of time and resources were wasted in that process.

The team uncovered that most of the denials were due to the age of the patient and the type of tumor they had. Some patients over age 18 develop a type of cancer that physicians deem pediatric because of how the tumor behaves.

Those cancers include neuroblastoma, rhabdomyosarcoma, germinoma and Ewing sarcoma. Physicians usually treat the cancer the same way they would treat a pediatric patient, but this patient population was initially denied four times as often as those 18 or younger.

In addition, cancers located outside the brain or spine were 4.5 times more likely to be denied. That may be due to the fact that the strongest evidence for pediatric proton therapy involves brain and spine tumors.

The appeal process took about a week on average and involved letters, peer-to-peer phone calls, or both in some cases. In 28 percent of the cases, multiple rounds of appeal were required before coverage was finally approved.

The team cautions that the study had limitations and that research will have to be conducted in other regions of the U.S. to confirm these results. A center in another part of the country would have its own mix of insurance carriers and plans, which could lead to different findings.

Penn also has an advisory board that assesses patients for proton therapy and only recommends those most likely to benefit from treatment. If another center skips that step, they may have more denials or fewer appeal reversals.

Ojerholm believes that there should be a way to streamline the approval process. He suggests changing the language of insurance policies to recognize the distinction of pediatric tumors, and classifying patients between ages 19 and 30 with pediatric cancers as pediatric cases.

“If the results are confirmed [in another study], then as a second step we could alert insurance companies to these data,” he said. “Ideally, this would prompt a discussion about ways to streamline the approval process for pediatric patients.”

Oncology Homepage

You Must Be Logged In To Post A Comment

Increase Your
Brand Awareness
Auctions + Private Sales
Get The
Best Price
Buy Equipment/Parts
Find The
Lowest Price
Daily News
Read The
Latest News
Browse All
DOTmed Users
Ethics on DOTmed
View Our
Ethics Program
Gold Parts Vendor Program
Receive PH
Gold Service Dealer Program
Receive RFP/PS
Healthcare Providers
See all
HCP Tools
A Job
Parts Hunter +EasyPay
Get Parts
Recently Certified
View Recently
Certified Users
Recently Rated
View Recently
Certified Users
Rental Central
Rent Equipment
For Less
Sell Equipment/Parts
Get The
Most Money
Service Technicians Forum
Find Help
And Advice
Simple RFP
Get Equipment
Virtual Trade Show
Find Service
For Equipment
Access and use of this site is subject to the terms and conditions of our LEGAL NOTICE & PRIVACY NOTICE
Property of and Proprietary to, Inc. Copyright ©2001-2017, Inc.