Bobby Koneru, Vice Chairman of the American Radium Society, Founder and President of POG, shared on LinkedIn:
“We often talk about the financial burden of insurance denials on patients and physicians. But what about the cost to the insurers themselves?
Consider eviCore’s decision to restrict coverage for low-dose radiotherapy (LDRT) in osteoarthritis despite growing randomized clinical evidence.
There are approximately 5,100 practicing radiation oncologists in the United States. If each requested just ONE peer-to-peer review, that would generate approximately 5,100 reviews. At an estimated $100–$200 in physician and administrative resources per review, that’s $500,000–$1 million in review costs.
Now imagine 10 reviews per physician. That’s potentially $5–10 million in review resources.
These are illustrative estimates, not verified eviCore expenditures. But they reveal something important about the economics of prior authorization.
The system works partly because physicians absorb the burden of fighting denials. We spend our time gathering evidence, writing appeals, and advocating for patients—often without reimbursement for those efforts.
What happens when that burden becomes organized, systematic, and impossible to ignore? Every medically justified peer-to-peer review creates an opportunity to challenge the clinical rationale, document inconsistencies, and demand accountability.
And when those experiences are collected across institutions, individual appeals become something much more powerful: evidence of how coverage policies are affecting patient care.
The Radiotherapy Access Alliance (RAA) is already challenging eviCore’s policy.
Perhaps the next step is a coordinated national effort to ensure that every clinically appropriate LDRT denial receives a meaningful review. Not to overwhelm the system for its own sake, but to hold it accountable to the evidence.
Because if insurers can deny care with a blanket policy, physicians should be equally determined to demand individualized clinical review.
Patients deserve that much.”
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