An Analysis of Inpatient Rehabilitation Approval Among Private Insurance Carriers at a Cancer Center

Abstract

Background Acute inpatient rehabilitation is often utilized by cancer patients to assist with discharge home and/or preparation for further treatment. Private insurance patients often require approval before transfer to acute inpatient rehabilitation. Objective To analyze the approval rate of private insurance carriers for acute inpatient cancer rehabilitation. Design Retrospective Analysis Setting Tertiary Referral Based Cancer Center Patients Ninety-six consecutive unique patients with private insurance who had acute inpatient rehabilitation authorization requests made between 4/1/2014 and 9/17/2014. Intervention Patient cases were assessed by a physiatrist, deemed clinically appropriate for acute inpatient rehabilitation, and submitted to private insurance payers for an approval request. Results Eighty seven percent (84/96) of requests for private insurance authorization for inpatient rehabilitation transfer were approved. Of the 96 cases, 14 (14.6%) cases were initially denied. Nine out of 96 (9.4%) progressed to a peer to peer appeal, of which only 2/9 (11.1%) resulted in approval for inpatient rehabilitation transfer (p=.222). The insurance carriers represented were Insurance A (46 patients, 48%), Insurance B (18 patients, 19%), Insurance C (12 patients, 13%), and Other Insurances (20, 21%). Two of 46 Insurance A requests were initially denied as compared to 7/18 for Insurance B, 0/12 for Insurance C, and 4/20 for Other Insurances (p=.001). Patients with Insurance B (p=.002, OR=14) and Other Insurances (p=.062, OR=5.50) were more likely to get denied inpatient rehabilitation approval compared to Insurance A. No significant difference between mean functional independence measure scores for approved and denied patients were found for transfers (p=.239) and mobility (p=.129) respectively. Conclusion Access to acute inpatient rehabilitation is unfortunately limited by insurers rather than clinical indicators. Future multi-center studies are needed. Universally accepted guidelines regarding inpatient rehabilitation criteria are needed.

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