Treating a Patient Denied Coverage Based on Not Conforming to NCCN Guidelines

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07/18/23

James L. Mohler, MD, Chair of the National Comprehensive Cancer Network (NCCN) Prostate Panel, discusses approaches for urologists dealing with insurance coverage denial for patients who do not fit within NCCN guidelines for prostate cancer. He outlines the iterative, bias-free process of creating the guidelines, which allows for a quick response to the latest research. Dr. Mohler further details how the guidelines value efficacy, quantity/quality of evidence, consistency of evidence, and safety above affordability, and how this can lead to denial of coverage. He then outlines talking points for overcoming guideline-based reasons for rejection from insurance providers.