An increasing number of insurance carriers are providing reimbursement for radio-frequency ablation of unresectable liver lesions. The move may spark an explosion in RFA-related procedures.
There is a pattern of positive reimbursement policies among the largest private insurance payers in the nation, said Lynn Saccoliti, vice president of reimbursement affairs for RITA Medical Systems, a manufacturer of RF equipment.
The companies have based their decisions on newly published long-term clinical data as well as respected technology assessment publications, she said.
"In addition to the organizations that have already adopted positive reimbursement policies, many insurers are currently in some stage of the coverage review process," Saccoliti said. "We expect those organizations to complete their reviews in the next three to six months."
Blue Cross/Blue Shield announced in early March its procurement of positive reimbursement policies for the treatment of liver cancer with RFA. The Blues have positive written reimbursement policies in 24 states, including Florida, Massachusetts, Michigan, and New York. Other large insurance companies providing liver RFA reimbursement include Aetna, United Health Care, and Humana.
Carriers like Humana, of Louisville, KY, also look positively at reimbursement beyond the liver. The company periodically reviews the medical literature for updates in treatment strategies concerning other organs, said Mary Sellers, Humana's corporate spokeswoman. If the literature proves too sparse or does not clearly indicate RFA's benefits, however, reimbursement will go instead toward generally accepted treatment standards as requests come in.
Despite limitations, the trend toward positive liver RFA reimbursement benefits patients with liver tumors not amenable to surgery. Many of these could not benefit from alternatives in the past because of the lack of coverage, said Dr. Mahmood K. Razavi, an associate professor of radiology at Stanford University.
"More people would be able to undergo RFA, which in appropriately selected patients will have a positive impact on their quality of life and, potentially, on their survival," Razavi said.
Improved reimbursement will also open the door for further advancement of minimally invasive alternatives to surgery, he said.
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