Insurance companies line up to reimburse for liver RFA

May 1, 2004

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.

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.

A pattern of positive reimbursement policies can be seen among the largest private insurance payers in the nation, said Lynn Saccoliti, vice president of reimbursement affairs for Rita Medical Systems, a manufacturer of RFA equipment.

Carriers have based their decisions on newly published long-term clinical data as well as on 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. We expect those organizations to complete their reviews by the third quarter," Saccoliti said.

Blue Cross/Blue Shield announced in early March its positive reimbursement policies for the treatment of liver cancer with RFA. The Blues have reimbursement policies in 24 states, including Florida, Massachusetts, Michigan, and New York. Other large insurance companies that provide liver RFA reimbursement include Aetna, UnitedHealthcare, and Humana.

Humana, of Louisville, KY, periodically reviews the medical literature for updates in treatment strategies concerning RFA in other organs, said Mary Sellers, the company's corporate spokesperson. If the literature proves too sparse or does not clearly indicate benefits for RFA, however, reimbursement is directed toward generally accepted treatment standards.

Improved reimbursement will open the door for further advancement of minimally invasive alternatives to surgery, said Dr. Mahmood K. Razavi, an associate professor of radiology at Stanford University.

"More people will be able to undergo RFA, which in appropriately selected patients will have a positive impact on their quality of life and, potentially, their survival," Razavi said.