Published On: March 1st, 2024Categories: Case StudiesTags:

Resolving Insurance Denial & Treatment Protocol Discrepancies

Research shows that cancer navigation services, such as Navvisa lead to an average of 43 days shorter time to treatment, $34.5K lower medical costs in the first year, and a 9% reduction in mortality.

Approximately one-half of adult cancer patients experience clinically significant psychological distress. 2 Distress not only naturally diminishes quality of life, but it can also interfere with patients’ treatment compliance, thereby affecting treatment outcomes. Patient navigation assists individuals in overcoming obstacles encountered across the entire cancer care continuum and can help address issues of access and quality of cancer care.

Navvisa Patient Case Study

A patient with prostate cancer was beginning treatment when Navvisa became involved. The patient’s oncologist recommended 45 radiation treatment sessions, but his insurance company only authorized 28 sessions. This insurance denial understandably caused distress for the patient.

Navvisa Nurse Intervention

Navvisa’s Certified Oncology Nurse — who specializes in this patient’s type of cancer— supported the patient by providing the information necessary to make a strong appeal to the insurance company. However, our nurse also reassured him that the National Standard of Care for his type and stage of cancer was, in fact, the 28 sessions that his insurance company approved.

The patient’s appeal was ultimately denied, but because of his trusting relationship with the Navvisa nurse, the patient entered his treatment calm and confident that he was receiving the optimal standard of care for his situation. In addition, the patient’s oncologist acknowledged that 45 treatments may have been “excessive.”

Clinical Impact & Cost Savings

A positive, and trusting mental state during treatment is critical to the success of any cancer treatment. Having a highly experienced Navvisa oncology nurse at his side provided this patient with the confidence needed to begin treatment quickly, helping avoid treatment delays and potential disease progression.

Relevant Research

  1. Patient Navigation Effects on Cancer Patients’ Quality of Life and Distress
  2. Implementation of NCCN distress management guidelines by member institutions
  3. Patient navigation across the cancer care continuum

More Resources

Interested in creating a cancer navigation plan specific to your organization’s needs? Reach out to us today or email us at [email protected]