Insurance Authorization and Access to Proton Therapy for Patients With Head and Neck Cancers

Mark W McDonald; James E Bates; Neal S McCall; Subir Goyal; Yuan Liu; Soumon Rudra; Jill S Remick; Sibo Tian; Mark W El-Deiry; Nabil F Saba; William A Stokes; Erica Swinney

doi:10.1016/j.ijrobp.2023.02.033

Insurance Authorization and Access to Proton Therapy for Patients With Head and Neck Cancers

Int J Radiat Oncol Biol Phys. 2023 Jun 1;116(2):404-412. doi: 10.1016/j.ijrobp.2023.02.033. Epub 2023 Mar 7.

Authors

Affiliations

¹ Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia. Electronic address: mark.mcdonald@emory.edu.
² Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
³ Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia.
⁴ Biostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
⁵ Department of Otolaryngology Head and Neck Surgery, Winship Cancer Institute of Emory University, Atlanta, Georgia.
⁶ Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.

PMID: 36889515
DOI: 10.1016/j.ijrobp.2023.02.033

Abstract

Purpose: We evaluated our institutional experience to assess potential racial inequities in insurance coverage for proton therapy in patients with head and neck (HN) cancer.

Methods and materials: We examined the demographics of 1519 patients with HN cancer seen in consultation at our HN multidisciplinary clinic (HN MDC) and 805 patients for whom a proton insurance authorization was sought (PAS) from January 2020 to June 2022. The prospects for proton therapy insurance authorization were prospectively noted based on each patient's ICD-10 (International Classification of Diseases, 10th Revision) diagnosis code and their specific insurance plan. Proton-unfavorable (PU) insurance were those plans whose policy describes proton beam therapy as "experimental" or "not medically necessary" for the given diagnosis.

Results: For patients seen in our HN MDC, Black, Indigenous, and people of color (BIPOC) were significantly more likely to have PU insurance than non-Hispanic White (NHW) patients (24.9% vs 18.4%, P = .005). In multivariable analysis including race, average income of residence ZIP code, and Medicare eligibility age, BIPOC patients had an odds ratio of 1.25 for PU insurance (P = .041). In the PAS cohort, while there was no difference in the percentage of patients receiving insurance approval for proton therapy between NHW and BIPOC populations (88% vs 88.2%, P = .80), for patients with PU insurance, the median time to determination was significantly longer (median, 15.5 days), and the median time to start any radiation of any modality was longer (46 vs 35 days, P = .08). Compared with NHW patients, the median time from consultation to start of radiation therapy was longer for BIPOC patients (37 vs 43 days, P = .01).

Conclusions: BIPOC patients were significantly more likely to have insurance plans unfavorable to proton therapy coverage. These PU insurance plans were associated with a longer median time to determination, a lower approval rate for proton therapy, and a longer time to start radiation of any modality.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Head and Neck Neoplasms* / radiotherapy
Humans
Income
Insurance Coverage
Medicare
Proton Therapy*
Protons
United States

Substances

Protons

Grants and funding

P30 CA138292/CA/NCI NIH HHS/United States