Penn research finds gap between policy language and eventual decisions

Ninety-Seven Percent of Insurance Denials in Pediatric Proton Patients Overturned on Appeal
August 07, 2017

Researchers from the Perelman School of Medicine at the University of Pennsylvania have poured through five years of pediatric insurance claims and thier outcomes. The surprising result is that 97% of the denied claims pediatric claims were approved after they were challenged. A good summary of the findings was described in the UPENN article as:

"The Penn team looked at five years of insurance coverage data for pediatric proton cases in the Roberts Proton Therapy Center spanning from 2010 to 2015. Of the 287 cases they evaluated, 255 (89 percent) were approved outright while 32 (11 percent) were initially denied. Following appeals, 31 of 32 initially denied cases (97 percent) were overturned and approved."

If you would like to read more detail on the study, UPENN published their findings in Pediatric Blood & Cancer here.