After careful review of clinical information and plan benefit, alert TPA and case manager of this phase I/II BMT study protocol.
With the employer’s decision on the non-covered experimental service, the patient was informed and presented with alternative treatment plan.
Result: The patient did not pursue the experimental transplant and opted for the conventional chemotherapy.
Savings and benefit: over $200,000 on the BMT and positive feedback from the TPA and broker on the case handling. The denial burden and decision was presented to the employer/TPA with the treatment information.