Insurance Authorization Barriers in Patients Undergoing Cytoreductive Surgery and HIPEC

• Published in: Annals of surgical oncology 2023-01, Vol.30 (1), p.417-422
• Main Authors: Ong, Cecilia T., Dhiman, Ankit, Smith, Anthony, Jose, Angela, Kallakuri, Pujitha, Belanski, Jennifer, Sood, Divya, Witmer, Hunter D. D., Morgan, Ryan B., Turaga, Kiran K., Eng, Oliver S.
• Format: Article
• Language: English
• Subjects: Aged; Chemotherapy; Claims processing; Cytoreduction Surgical Procedures; Demographics; Female; Gastric cancer; Gynecological cancer; Histology; Humans; Hyperthermic Intraperitoneal Chemotherapy; Insurance coverage; Male; Malignancy; Medicaid; Medical prognosis; Medicine; Medicine & Public Health; Mesothelioma; Middle Aged; Oncology; Ovaries; Patients; Peritoneal Surface Malignancy; Surgery; Surgical Oncology; Tumors
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-022-12437-9

Background Indications for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) exist across multiple histologies, but little data exist on the impact of insurance authorization on access to these therapies. Given the evolving role of CRS/HIPEC, we sought to characterize insurance approval and delays in patients undergoing these therapies. Patients and Methods A retrospective review was performed at a high-volume tertiary center of patients who received CRS/HIPEC from 2017 to 2021. Collected data included patient demographics, tumor histologic characteristics, insurance type, approval/denial history, and time to prior authorization approval. Descriptive statistics were performed. Results In total, 367 patients received CRS/HIPEC during the study period. They had a median age of 59 (IQR 49–67) years, 35% were male, and 76% were white. Of the patients requiring prior authorization, 14 of 104 (13%) patients were denied prior authorization and required appeal. Median time between authorization request and approval was 33 (IQR 28–36) days. These cases generated 410 insurance authorization requests, 94 (23%) of which were not initially approved and required appeal. The rate of upfront denial was 21.1% in patients with public insurance compared with 23.4% in patients with private insurance. Gastric cancer was the most common histology among denied cases (55%), followed by colorectal, appendiceal, and gynecologic malignancies. Conclusions Despite the broadening indications for and data supporting CRS/HIPEC, a significant proportion of patients still face hurdles in attaining insurance approval and coverage for these therapies. Addressing barriers to insurance approval is imperative to decrease therapeutic delay and improve access to data-driven care.