Cecilia Ong, MD
Surgical Oncology Fellow
University of Chicago
Chicago, Illinois, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Clinical indications for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) exist across multiple histologies, but there are little data on the impact of insurance authorization on access to these therapies. Given the evolving landscape of CRS/HIPEC in the management of peritoneal surface malignancies, we sought to characterize insurance approval and delays in patients undergoing CRS/HIPEC.
Methods:
A retrospective review was performed at a high-volume tertiary center of patients who received CRS and/or HIPEC from 2017-2021. Collected data included patient demographics, histologic characteristics, type of insurance, approval/denial history, and time to approval. We profiled patients who were either approved upfront, approved after appeal (not initially approved), or denied upfront. Descriptive statistics were performed.
Results:
In total, 367 patients received CRS and/or HIPEC during the study period. They had a median age of 59 years (IQR 51-67), 56% were female, and 79% were white. These cases generated 390 separate insurance authorization requests. 97 of these were not initially approved, of which 65 were from private insurance and 32 from Medicare/Medicaid. Upfront denials by histology are shown in the Table. Of these appealed claims, 27% of the private insurance claims were ultimately denied compared to 37% from Medicare/Medicaid (p = 0.32). The mean time between claim submission and final decision was 30 days in those who had a successful appeal compared to 41 days in those who were ultimately denied. The denial rate ranged between 4-9% by fiscal year. Gastric cancer was the most common histology among denied cases (58%), followed by colorectal (24%), and appendix (22%, p< 0.001).
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.