Insurance coverage decisions for pediatric proton therapy.
Pediatr Blood Cancer
; 65(1)2018 Jan.
Article
em En
| MEDLINE
| ID: mdl-28782877
ABSTRACT
Proton beam therapy (PBT) holds promise for pediatric patients, but level 1 evidence is not available. In this context, we examined insurance coverage decisions at our facility from 2010 to 2015. PBT was initially denied for 11% of pediatric cases. However, nearly all denials were overturned on appeal-a process that often delayed care by more than a week. Despite unfavorable language in coverage policies, real-world decisions were eventual approval in >99% of cases. Payers appear to have largely accepted the current level-of-evidence for pediatric PBT, but all parties spend significant time and resources on appeals. Streamlined approval processes could align incentives among stakeholders.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Cobertura do Seguro
/
Tomada de Decisões
/
Terapia com Prótons
/
Neoplasias
Tipo de estudo:
Prognostic_studies
Limite:
Adult
/
Child
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Child, preschool
/
Female
/
Humans
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Infant
/
Male
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article