
Navigating Medical Insurance Delays and Denials: Insights from Patients, ASTRO and the Press
Navigating medical insurance for radiation treatment in the United States is frustrating and complex, often resulting in disappointment for patients, delays in care, and denials of standard of care treatment. Surveys show little standardization of denial processes, with few patients (<1/6) initiating appeals. This activity consists of key stakeholders including a patient/family member, an ASTRO health policy analyst, and a reporter who has extensively studied denials. They shed light on navigation, advocacy, and enacting change. Representing the patient perspective, our speaker is the wife of a cancer patient, a nurse and former senior health care administrator and educator. She shares the personal impacts of treatment denials and lessons learned for successful appeals. The second panelist is a health policy analyst from ASTRO who will discuss the impacts of prior authorization, ASTRO’s efforts behind the scenes with CMS and insurers, and resources ASTRO offers for solutions. Our third panelist is a reporter who has published extensively on issues related to insurance denials. She discusses her findings about variation of denials across insurers, the rights of patients and providers in this process, and ways to support patients on a local and national scale. This activity provides proactive strategies for providers and patients to address medical insurance delays and denials. We also highlight the role of radiation oncologists in advocating for and activating patient involvement in this process.
Topics:
- Introduction
Charles C. Hsu, MD, PhD - A Patient and Family Perspective on Navigating Medical Insurance Denials
Gerri Lamb, PhD, RN, FAAN - Opening the Black Box: What You Suspect is Probably True
Patrick Michael Rucker, BS - Prior Authorization Impact and ASTRO Advocacy
Emilio Beatley, BS - Q and A
Charles C. Hsu, MD, PhD - Moderator
Full Panel
This activity is available from January 28, 2025, through 11:59 p.m. Eastern time on January 27, 2027.
This activity was originally recorded at the 2024 ASTRO Annual Meeting.
Target Audience
The activity is designed to meet the interests of medical oncologists, radiation oncologists, nurses, residents, patients, patient advocates and healthcare administrators.
Learning Objectives
Upon completion of this activity, participants should be able to:
- Determine ways to better navigate prior authorization and denials of radiation treatment.
- Discuss larger issues involving medical care denial and ways to advocate for our patients.
- Charles C. Hsu, MD, PhD, is employed by University of Arizona. Dr. Hsu serves as medical director for the clinical trials office within the University of Arizona Cancer Center.
- Gerri Lamb, PhD, RN, FAAN, is retired from Arizona State University. Dr. Lamb receives compensation as a consultant from San Carlos Apache Healthcare. Dr. Lamb serves an uncompensated role on the advisory board with the National Committee on Quality Assurance (NCQA). Dr. Lamb serves as Chair of strategic relationships with the Case Management Society of America.
- Patrick Michael Rucker, BS, is employed by Capitol Forum.
- Emilio Beatley, BS, is employed by ASTRO.
The person(s) above served as the developer(s) of this activity. Additionally, the Education Committee had control over the content of this activity. All relevant relationships have been mitigated.
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Available Credit
- 1.00 AMA PRA Category 1 Credit™The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- 1.00 Certificate of AttendanceThis activity was designated for 1.00 AMA PRA Category 1 Credit™.
Price
Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.
Nonmember: $149
Member: $99
Member-in-training: $49
Student/Grad Student/PGY: $49
Postdoctoral Fellow: $49
If you are an ASTRO member from a low or lower-middle income country, as identified by the World Bank, you can receive a 50% discount off your corresponding registration for this activity. Please email [email protected] to inquire about the discount.
Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the course by the end of the qualification date. The qualification date for each course is listed in the course catalog on the ASTRO website under availability.
Participants using ASTRO's online courses to satisfy the requirement of a Maintenance of Certification (MOC) program should verify the number, type and availability dates of any course before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased courses that do not align with their MOC requirement.
The course and its materials will only be available on the ASTRO website until January 27, 2027, regardless of purchase date. At the expiration of the qualification, participants will no longer have access to the course or its materials. ASTRO reserves the right to remove a course before the end of its qualification period.
Required Hardware/software
One of the two latest versions of Google Chrome, Mozilla Firefox, Internet Explorer or Safari.