Medicare Advantage plans had higher rates of inappropriate denials for radiation therapy than for all other health services, a recent analysis found.
Medicare Advantage plans are expected to cover all services that Traditional Medicare covers . Radiotherapy services for cancer are included in Medicare Advantage plan coverage.
The researchers extracted data that contained appeal decisions from the Centers for Medicare & Medicaid Services website between 2022 through June 2024, focusing on decisions by an Independent Review Entity, which determines the appropriateness of a denial based on Medicare guidelines. Researchers assessed decisions for trends across treatment modalities and diagnoses, including brachytherapy, stereotactic body radiation therapy, proton therapy, and Intensity-Modulated Radiation Therapy .Over the study period, 274 of 1576 radiotherapy appeals were inappropriately denied by Medicare Advantage plans compared with 20,195 of 433,788 appeals for all health services.
However, inappropriate denial rates also varied by cancer type. For instance, the rate of inappropriate denials for breast cancer IMRT, specifically, was quite high, at about 82.1%, whereas the rate for proton therapy to treat prostate cancer was quite low, at about 3.5%.
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