Getting insurance coverage for SBRT

I know that Medicare covers SBRT, but some private insurers consider it experimental even though there is 6 years of data. Their refusal makes even less sense to me because the cost is about half of IMRT. Go figure!

Last year ASTRO (American Society of Radiation Oncologists) endorsed SBRT. NCCN just gave it a cautious endorsement in their new physician guidelines (Version 1.2014):

NCCN said...
Extremely hypofractionated image-guided IMRT/SBRT (6.5 Gy per fraction or greater) are an emerging treatment modality with single institutional and pooled reports of similar efficacy and toxicity to conventionally fractionated regimens. They can be considered as a cautious alternative to conventionally fractionated regimens at clinics with appropriate technology, physics, and clinical expertise." (PROS D 1 of 2)

So if your insurance company has turned it down, you may want to resubmit/appeal with this new information.

Medical insurance is fraught with difficulty at its best, and can be incalculably complicated when trying to get coverage for cancer treatment. Insurance companies advocate for--you guessed 'er, Chester--insurance companies, not the individual seeking coverage.

I would strongly suggest that anyone navigating the tricky waters of coverage get an insurance advocate working for you. Here is an excellent book, expertly and accurately written, that is guaranteed to be helpful to anyone who has insurance: Health Insurance: Navigating Traps & Gaps by Maura Carley. The book is readily available from most public libraries or from your favorite book seller.

I've read  too many sad stories here about missing, bad, insufficient, or refused coverage. Knowledge, in this case, is power.   

Post Edited (Tim G) : 12/12/2013 8:43:12 PM (GMT-7)