{"id":"https://openalex.org/W4288886072","doi":"https://doi.org/10.1016/j.ijrobp.2022.07.1839","title":"Variations in Medical Necessity Determinations Across Commercial Insurance Carriers for Prostate Cancer Procedures","display_name":"Variations in Medical Necessity Determinations Across Commercial Insurance Carriers for Prostate Cancer Procedures","publication_year":2022,"publication_date":"2022-07-30","ids":{"openalex":"https://openalex.org/W4288886072","doi":"https://doi.org/10.1016/j.ijrobp.2022.07.1839","pmid":"https://pubmed.ncbi.nlm.nih.gov/35918053"},"language":"en","primary_location":{"id":"doi:10.1016/j.ijrobp.2022.07.1839","doi":"https://doi.org/10.1016/j.ijrobp.2022.07.1839","is_oa":false,"landing_page_url":"https://doi.org/10.1016/j.ijrobp.2022.07.1839","pdf_url":null,"source":{"id":"https://openalex.org/S110533041","display_name":"International Journal of Radiation Oncology*Biology*Physics","issn_l":"0360-3016","issn":["0360-3016","1879-355X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-2","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"International Journal of Radiation Oncology*Biology*Physics","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5001457923","display_name":"Xinglei Shen","orcid":"https://orcid.org/0000-0003-0337-860X","observed_orcids":["https://orcid.org/0000-0003-0337-860X"]},"institutions":[{"id":"https://openalex.org/I4210128618","display_name":"University of Kansas Medical Center","ror":"https://ror.org/036c9yv20","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210128618"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Xinglei Shen","raw_affiliation_strings":["Department of Radiation Oncology, University of Kansas Medical Center, Kansas City Kansas. Electronic address: xshen@kumc.edu","Department of Radiation Oncology, University of Kansas Medical Center, Kansas City Kansas"],"raw_orcid":"https://orcid.org/0000-0003-0337-860X","affiliations":[{"raw_affiliation_string":"Department of Radiation Oncology, University of Kansas Medical Center, Kansas City Kansas. Electronic address: xshen@kumc.edu","institution_ids":["https://openalex.org/I4210128618"]},{"raw_affiliation_string":"Department of Radiation Oncology, University of Kansas Medical Center, Kansas City Kansas","institution_ids":["https://openalex.org/I4210128618"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5076238068","display_name":"Daniel Eidelberg Spratt","orcid":"https://orcid.org/0000-0002-5973-4741","observed_orcids":["https://orcid.org/0000-0002-5973-4741"]},"institutions":[{"id":"https://openalex.org/I4210108791","display_name":"University Hospitals Cleveland Medical Center","ror":"https://ror.org/01gc0wp38","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2799343972","https://openalex.org/I4210108791"]},{"id":"https://openalex.org/I4210119077","display_name":"University Hospitals Seidman Cancer Center","ror":"https://ror.org/02kb97560","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I2799343972","https://openalex.org/I4210119077"]},{"id":"https://openalex.org/I4390039247","display_name":"Case Comprehensive Cancer Center","ror":"https://ror.org/00fpjq451","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4390039247","https://openalex.org/I58956616"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Daniel E. Spratt","raw_affiliation_strings":["Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland Ohio"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Radiation Oncology, University Hospitals, Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland Ohio","institution_ids":["https://openalex.org/I4210108791","https://openalex.org/I4210119077","https://openalex.org/I4390039247"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5041418355","display_name":"Stacie B. Dusetzina","orcid":"https://orcid.org/0000-0002-3907-9196","observed_orcids":["https://orcid.org/0000-0002-3907-9196"]},"institutions":[{"id":"https://openalex.org/I901861585","display_name":"Vanderbilt University Medical Center","ror":"https://ror.org/05dq2gs74","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210162197","https://openalex.org/I901861585"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Stacie B. Dusetzina","raw_affiliation_strings":["Department of Health Policy, Vanderbilt Medical Center, Nashville, Tennessee"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Health Policy, Vanderbilt Medical Center, Nashville, Tennessee","institution_ids":["https://openalex.org/I901861585"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5009288889","display_name":"R. C. Chen","orcid":"https://orcid.org/0000-0002-4590-8640","observed_orcids":["https://orcid.org/0000-0002-4590-8640"]},"institutions":[{"id":"https://openalex.org/I4210128618","display_name":"University of Kansas Medical Center","ror":"https://ror.org/036c9yv20","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I4210128618"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Ronald C. Chen","raw_affiliation_strings":["Department of Radiation Oncology, University of Kansas Medical Center, Kansas City Kansas"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Department of Radiation Oncology, University of Kansas Medical Center, Kansas City Kansas","institution_ids":["https://openalex.org/I4210128618"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5001457923"],"corresponding_institution_ids":["https://openalex.org/I4210128618"],"apc_list":{"value":3600,"currency":"USD","value_usd":3600},"apc_paid":null,"fwci":0.5879,"has_fulltext":false,"cited_by_count":3,"citation_normalized_percentile":{"value":0.75735736,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":{"min":88,"max":95},"biblio":{"volume":"115","issue":"1","first_page":"34","last_page":"38"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.7764000296592712,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.7764000296592712,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T10124","display_name":"Prostate Cancer Diagnosis and Treatment","score":0.17569999396800995,"subfield":{"id":"https://openalex.org/subfields/2748","display_name":"Urology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T12708","display_name":"Economic and Financial Impacts of Cancer","score":0.007199999876320362,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/prostate-cancer","display_name":"prostate cancer","score":0.8389999866485596},{"id":"https://openalex.org/keywords/metastatic-prostate-cancer","display_name":"metastatic prostate cancer","score":0.8069999814033508},{"id":"https://openalex.org/keywords/hydrogel-spacer","display_name":"hydrogel spacer","score":0.8629999756813049},{"id":"https://openalex.org/keywords/intensity-modulated-radiotherapy","display_name":"intensity-modulated radiotherapy","score":0.9760000109672546},{"id":"https://openalex.org/keywords/access-to-cancer-care","display_name":"access to cancer care","score":0.8349999785423279}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8125174641609192},{"id":"https://openalex.org/C2780192828","wikidata":"https://www.wikidata.org/wiki/Q181257","display_name":"Prostate cancer","level":3,"score":0.6975440979003906},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.5000128746032715},{"id":"https://openalex.org/C2778137410","wikidata":"https://www.wikidata.org/wiki/Q2732820","display_name":"Government (linguistics)","level":2,"score":0.44865602254867554},{"id":"https://openalex.org/C121608353","wikidata":"https://www.wikidata.org/wiki/Q12078","display_name":"Cancer","level":2,"score":0.4296432137489319},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.4029281735420227},{"id":"https://openalex.org/C126322002","wikidata":"https://www.wikidata.org/wiki/Q11180","display_name":"Internal medicine","level":1,"score":0.2495708167552948},{"id":"https://openalex.org/C138885662","wikidata":"https://www.wikidata.org/wiki/Q5891","display_name":"Philosophy","level":0,"score":0.0},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.0},{"id":"https://openalex.org/C41895202","wikidata":"https://www.wikidata.org/wiki/Q8162","display_name":"Linguistics","level":1,"score":0.0},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.0}],"mesh":[{"descriptor_ui":"D000368","descriptor_name":"Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006278","descriptor_name":"Medicare","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007343","descriptor_name":"Insurance Carriers","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011471","descriptor_name":"Prostatic Neoplasms","qualifier_ui":"Q000000981","qualifier_name":"diagnostic imaging","is_major_topic":true},{"descriptor_ui":"D011471","descriptor_name":"Prostatic Neoplasms","qualifier_ui":"Q000532","qualifier_name":"radiotherapy","is_major_topic":true},{"descriptor_ui":"D014057","descriptor_name":"Tomography, X-Ray Computed","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D014481","descriptor_name":"United States","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D017430","descriptor_name":"Prostate-Specific Antigen","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D019458","descriptor_name":"Insurance Coverage","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D020100","descriptor_name":"Hydrogels","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1016/j.ijrobp.2022.07.1839","doi":"https://doi.org/10.1016/j.ijrobp.2022.07.1839","is_oa":false,"landing_page_url":"https://doi.org/10.1016/j.ijrobp.2022.07.1839","pdf_url":null,"source":{"id":"https://openalex.org/S110533041","display_name":"International Journal of Radiation Oncology*Biology*Physics","issn_l":"0360-3016","issn":["0360-3016","1879-355X"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-2","ki-jl-1","medline","norway-1","poland-140","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"International Journal of Radiation Oncology*Biology*Physics","raw_type":"journal-article"},{"id":"pmid:35918053","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/35918053","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"International journal of radiation oncology, biology, physics","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":0.9391000270843506}],"study_designs":[],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":14,"referenced_works":["https://openalex.org/W1999130958","https://openalex.org/W2592338623","https://openalex.org/W2725968597","https://openalex.org/W2783091042","https://openalex.org/W2897236707","https://openalex.org/W2897670539","https://openalex.org/W2904485645","https://openalex.org/W2904856669","https://openalex.org/W2966792020","https://openalex.org/W3006668752","https://openalex.org/W3093921635","https://openalex.org/W3119433803","https://openalex.org/W3159813235","https://openalex.org/W3176042656"],"related_works":["https://openalex.org/W2601366716","https://openalex.org/W2794012504","https://openalex.org/W2600184455","https://openalex.org/W2140181708","https://openalex.org/W3199342400","https://openalex.org/W2407027487","https://openalex.org/W4253341504","https://openalex.org/W1969289987","https://openalex.org/W2789607935","https://openalex.org/W4292579030"],"abstract_inverted_index":null,"counts_by_year":[{"year":2024,"cited_by_count":2},{"year":2023,"cited_by_count":1}],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2022-07-31T00:00:00"}