Insurance Denial of IMRT for Prostate

[thompa]

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Anyone here run into this before? I've got a P2P tomorrow with Priority Health. They're denying IMRT for 28-fraction prostate treatment for an intemediate risk prostate cancer. They're telling me they'll only approve brachy or 3D.

This is the first time I've ever had IMRT denied for prostate. It's standard of care and am frankly shocked by the denial. Person I'm talking to tomorrow is not a rad onc. They don't have a rad onc to talk to. Are other folks seeing this kind of shenanigans?

 

[madchemist89]

Never seen this, but it is likely an error. You will likely get it approved.

 

[sirspamalot]

I can't have IMRT for my prostate cancer patient?

 

[TheWallnerus]

There’s gotta be some guideline somewhere they have to which you can refer.

 

[dieABRdie]

Anyone here run into this before? I've got a P2P tomorrow with Priority Health. They're denying IMRT for 28-fraction prostate treatment for an intemediate risk prostate cancer. They're telling me they'll only approve brachy or 3D.

This is the first time I've ever had IMRT denied for prostate. It's standard of care and am frankly shocked by the denial. Person I'm talking to tomorrow is not a rad onc. They don't have a rad onc to talk to. Are other folks seeing this kind of shenanigans?

There's a lot of "just deny it upfront going on."

Sometimes its just a reflex from policy that gets turned over easily.

Sometimes its a mistake.

Sometimes.... its them testing what they can get away with.

Fight it... every time.

 

[Reaganite]

Agree....have had a prostate or 2 reflexively denied for imrt. That being said, I have heard some large kaiser departments routinely do 3d for prostate.

 

[BobbyHeenan]

Probably a clerical error somewhere. Weird that brachy was approved, but in the past when I got an IMRT denial it was when patient was coded as having stage IV disease and they would approve palliative 3D for local symptoms but not IMRT.

If it's coded as localized prostate cancer correctly I bet it gets approved.

 

[A_DeMichele]

can you disclose which insurance / ROBM? I hope it’s an error

 

[evilbooyaa]

What a waste of everyone's time. Please update us. I have not ever had this issue before.