Table 3.

Key findings from interviews

Insurance barriers Number of survivors are increasing due to improved therapies, but payer policies are not expanding at the same rate	• Stricter payer policies with varying requirements and financial burden falls on patient • Excessive documentation (beyond medical necessity) required by payers with citations from publications to show the justification • Site of care is an issue (what is done at home vs. center) • Regarding bone density denial—denied because the breast cancer patient does not have osteoporosis, but due to their treatment they are at a higher risk • Prior authorization and peer-to-peer common for survivorship services, but an added step and burden for provider • Private payers seem to have the most barriers
Patient barriers	• Patients are not aware that the practice is working behind the scenes to get the services covered and when the patient receives the denial, adds stress to an already stressful situation • Patient health insurance literacy plays a role
Solutions Processes, systems, and models adopted by providers/practices	• Practices are aware which services will be denied and have processes in place to get these services for their patients—but require a team which all interviewees (except VA interviewee) have in place • Patient navigators and social workers help reduce barriers including identifying the resources needed (i.e., gas cards for rural patients, explaining their insurance coverage, and identifying community resources) • Finding the right billing code can reduce barriers