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• W2895840807 abstract "A significant clinical and administrative effort is required by most proton centers to coordinate insurance approval for patients. Many patients with malignancies where protons offer dosimetric advantage, such as medulloblastoma and sarcoma, require radiation therapy within a particular time range. The extent of coverage and average time for coverage decisions has not been studied. As part of an institutional review board approved institutional proton cohort registry, data was both retrospectively and prospectively gathered on dates of insurance submission and decision for patients of all ages at our Hospital and Proton Center between April 2016 and June 2017 (14 months). Factors associated with approval were analyzed. Over the timeframe, 612 submissions for insurance coverage were made. Sites included 554 (91%) adult and 58 (9%) pediatric patients (age≤21y at the time of insurance submission). The median time to decision was 6 days (0 to 158) for approved patients, and 39 days (range, 5 to 374) for denied patients (p<0.0001 via Wilcoxon rank-sum test). Among all patients, 49 (8%) of patients had a delay over 30 days, including 19 (3%) who had a delay over 60 days. The overall rate of insurance approval was 94% for all patients. Approval rate did not vary significantly by cancer site (p=0.15), age (p=0.15), and type of insurance (p=0.42). Nine (1.5%) patients self-funded their treatment. Overall, 292 (51%) of all patients ultimately received a median of 12 fractions (1 to 38) of proton radiation. Patients denied proton treatment face significant delay in time to eventual start of treatment with photons. This may have a critical effect in malignancies where radiation is time sensitive. This study may significantly overestimate the rate of insurance approval given provider self-selection to avoid plans that routinely reject protons.Abstract TU_11_3005; Table 1Variables associated with insurance approval timeVariableN= 612Site (Adult only)Head and neck56 (10%)CNS206 (37%)Lung32 (6%)Sarcoma94 (17%)Breast39 (7%)GU35 (6%)GI73 (13%)Heme6 (1%)Other6 (1%)Site (Peds only – age≤21y)Head and neck1 (2%)CNS43 (74%)Sarcoma11 (18%)GI1 (2%)Heme1 (2%)Other1 (2%)Percentage of Insurance Approval by AgeAdults98%Peds94%Percentage of Insurance Approval by SiteHead and neck95%CNS93%Lung97%Sarcoma95%Breast82%GU97%GI97%Heme86%Median time (and range) from Submission to Insurance Decision by AgeAdults7 days (0 to 374)Peds6 days (0 to 58)Median time from Submission to Insurance Decision by SiteHead and neck8 days (0 to 115)CNS6 days (0 to 158)Lung7 days (0 to 25)Sarcoma8 days (0 to 69)Breast8 days (0 to 98)GU5 days (0 to 59)GI5 days (0 to 374)Heme5 days (3 to 45)Median time from Submission to Insurance Decision by Insurance TypeMedicare/Medicaid3 days (0 to 374)Private Insurance7 days (0 to 158)International2 days (0 to 35)Time from Submission to Treatment Start (Proton or Photon)Median39 days (2 to 402)Delayed >30 days321 (58%)Delayed >60 days170 (31%) Open table in a new tab" @default.
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• W2895840807 date "2018-11-01" @default.
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• W2895840807 title "Insurance Coverage Approval Delay among Patients Receiving Proton Radiation Therapy" @default.
• W2895840807 doi "https://doi.org/10.1016/j.ijrobp.2018.07.1250" @default.
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