On February 16, ASTRO and Society for Radiation Oncology Administrators (SROA) leadership met with United Healthcare’s (UHC) radiation oncology program leaders to discuss concerns related to IMRT/IGRT denials, the peer-to-peer review process, and the UHC preauthorization process. Discussion topics were submitted to UHC in advance of the call, based ASTRO and SROA member feedback regarding recent payer experiences. UHC’s leaders were receptive to the concerns raised and agreed to follow up on key areas that warrant review.

Concerns about delays in delivery of care related to the UHC pre-authorization process were discussed during the call. It was explained that the UHC policy that disallows backdating the authorization prevents physicians from starting the simulation process in a timely manner. The group also discussed concerns regarding the development of comparison IMRT and 3-D plans and the frequency with which superior IMRT plans are denied. IGRT denials were also discussed and there was a commitment to share specific examples of inappropriate denials. The call ended with a discussion regarding UHCs efforts to update the peer-to-peer review process by employing more radiation oncologists to provide better case review.

What’s Next: ASTRO and SROA will follow up with UHC regarding the discussion and identify key areas where progress is being made to improve payer relations. A future call with UHC will be held in the fall.