Would you apply today?

[TheWallnerus]

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Out of curiosity - which regimens are being pushed that you feel have less efficacy?

Most insurance companies don’t allow SRS for SCLC brain mets and so instead push WBRT

Most insurance companies allow up to 21 fractions of RT for very low risk breast cancer and thus push increased toxicity and out of pocket costs where 5 fractions would be sufficient

Most insurance companies allow up to 35 fractions for stage III NSCLC pushing perhaps increased toxicity by doing so

Most insurance companies say protons and IMRT are equal for prostate cancer thus pushing the proton palaces to deliver more protons for prostate than they would otherwise

I could go on!

 

[drowsy12]

was more asking about efficacy specifically, SRS for SCLC is a fair example, though luckily I have not faced any pushback yet for it. also not a clean slam-dunk efficacy example of course. but if SRS was denied I would for sure have that as a battle worth fighting.

 

[OTN]

was more asking about efficacy specifically, SRS for SCLC is a fair example, though luckily I have not faced any pushback yet for it. also not a clean slam-dunk efficacy example of course. but if SRS was denied I would for sure have that as a battle worth fighting.

I've gotten denied SRS for SCLC. Fought it. Won. Too much time went by so that bought them another MRI (which did show change) and tx planning charge. *****s.

The word that is blurred out as offensive would be if you took the word Monon like Monon Trail in Indiana and replaced the first n with an r.

 

[TheWallnerus]

I've gotten denied SRS for SCLC. Fought it. Won. Too much time went by so that bought them another MRI (which did show change) and tx planning charge. *****s.

The word that is blurred out as offensive would be if you took the word Monon like Monon Trail in Indiana and replaced the first n with an r.

In the states of AL, GA, TN, the Virginias and the Carolinas, their LCD specifically prohibits SRS for SCLC. Medicare would deny this outright, but since there’s no specific ICD for SCLC brain Mets versus just “regular” brain mets, they pay. However, if you do it and get paid, you have committed fraud (in theory!). That LCD which has been present for about a year and a half is changing today however to eliminate the SCLC exclusion.