Ronald Chen, Professor and Chair of the Department of Radiation Oncology at the University of Kansas Medical Center, shared on LinkedIn:
”It’s not uncommon for insurance companies to deny medically-necessary cancer treatment for a patient. It’s a burden for both patients and physicians.
There is a pre-authorization process that’s required by insurance companies before a patient can receive treatment. If their authorization is denied, we have to go through an often prolonged appeal process – delaying patient care.
A recent American Medical Association survey shows that prior authorization consumes an average of 13 hours of physician and staff time each week.
13 Hours! Each Week!
The report also highlights ongoing concerns that prior authorization causes delay in care, disrupts treatment, and harms patient outcomes.
These are effects I’ve witnessed first-hand many times.
I’ve had a number of denials from insurance, and after going through the appeals process, I’ve been able to win 100% of these cases.
Winning 100% of appeals illustrates that the denials were incorrect from the start, leading to a delay in my patients’ care. Many appeals are getting overturned across the country, because denials were wrong in the first place.
For most cancer patients, if there is an incorrect denial by the insurance company, appeals need to be urgently reviewed to minimize delay in care. Just recently, I filed an urgent appeal, which requires a maximum 3-day turnaround by the insurance company. But, shockingly, the insurance company decided that this cancer case was not urgent, and triaged the review to a normal timeline which would take a month. And the insurance company made this decision without telling me (the physician) or the patient. This is not the first time this has happened.
How is this OK?
Also not OK is that most of the time, insurance companies have pediatricians or family physicians review appeals of cancer patient cases. In fact, I have found this to be true almost all the time.
Unfortunately, I have found these reviewers to lack the necessary medical knowledge to understand the specific issues relevant for the cancer patient’s case. These reviews simply are a way for the insurance company to delay patient care and frustrate the treating physician, who may often not have time to further pursue the appeal. Thus, the patient is left without being able to receive standard of care.
This has become a national issue, with a congressional bill trying to provide guidance and protect patients across the country, so they can get access to the care they need.”
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