Radiation Oncology Benefit Management companies (ROBMs) have entered the marketplace over the past several years as a result of increased use of IMRT and other radiation therapies that have significantly impacted claim costs to insurers. Private insurers hope to control the increasing costs of radiation treatment delivery and ensure appropriate usage of these services by contracting with ROBMs.
ASTRO endorses professionally developed and vetted clinical practice guidelines, appropriateness of care criteria and consensus-based model policies developed in a transparent manner with peer review and input as a foundation for clinical decision making. ASTRO opposes restrictive practice guidelines that oversimplify the process of individual patient management and abrogate the professional judgments that are often only possible within the private boundaries of a direct patient-doctor relationship.
ASTRO houses form appeal letters shared by radiation oncologists. The letters, divided by disease site, are available for use by all practices across the radiation oncology community. If you have a form letter you would like to share, you can email Senior Health Policy Analyst, Emilio Beatley.
SBRT for oligometastases appeal letter
IMRT for prostate appeal letter