Health Policy

Health Services Research/Global Oncology

EDU 03 - Navigating Medical Insurance Delays and Denials: Insights from Patients, ASTRO and the Press

Moderator(s)

• 

  Charles Hsu, MD, PhD

  University of Arizona College of Medicine Tucson
  Tucson, AZ

Navigating medical insurance for radiation treatment in the United States is frustrating and complex, often resulting in disappointment for patients, delays in care, and denials of standard of care treatment. Surveys show little standardization of denial processes, with few patients (<1/6) initiating appeals. This panel consists of key stakeholders including a patient/family member, an ASTRO health policy analyst, and a reporter who has extensively studied denials. They will shed light on navigation, advocacy, and enacting change.

Representing the patient perspective, our speaker is the wife of a cancer patient, a nurse and former senior health care administrator and educator. She will share the personal impacts of treatment denials and lessons learned for successful appeals. The second panelist is a health policy analyst from ASTRO who will discuss the impacts of prior authorization, ASTROs efforts behind the scenes with CMS and insurers, and resources ASTRO offers for solutions. Our third panelist is a reporter who has published extensively on issues related to insurance denials. She will discuss her findings about variation of denials across insurers, the rights of patients and providers in this process, and ways to support patients on a local and national scale. Our session will provide proactive strategies for providers and patients to address medical insurance delays and denials. We will also highlight the role of radiation oncologists in advocating for and activating patient involvement in this process.

Presentations:

• 8:00 AM – 8:07 AM ET

  Introductions
  

  Speaker: Charles Hsu, MD, PhD – University of Arizona College of Medicine Tucson
• 8:07 AM – 8:22 AM ET

  A Patient and Family Perspective on Navigating Medical Insurance Denials
  

  Speaker: Gerri Lamb, PhD, RN
• 8:22 AM – 8:37 AM ET

  Opening the Black Box: What You Suspect is Probably True
  

  Speaker: Patrick Rucker, BS – The Capitol Forum
• 8:37 AM – 8:52 AM ET

  Prior Authorization Impact & ASTRO Advocacy
  

  Speaker: Emilio Beatley, BS – American Society for Radiation Oncology
• 8:52 AM – 9:00 AM ET

  Questions and Answers
  

  Speaker: Charles Hsu, MD, PhD – University of Arizona College of Medicine Tucson