Nicole Stout, DPT, CLT-LANA, FAPTA, research assistant professor in the WVU School of Public Health Department of Health Policy, Management and Leadership, recently co-authored a call to action for payment and workforce policies that alleviate gaps in dental and oral healthcare services for individuals with cancer.
The paper, published last week in the Journal of Clinical Oncology, highlights policy changes that are needed to improve payment for dental services for individuals with cancer.
Currently, many dental procedures and oral healthcare services that are medically necessary for people with cancer are not covered by commercial medical or dental insurance plans. This leads to patients facing a difficult choice of paying out-of-pocket for these services, or choosing to forgo procedures that are needed to restore their oral function.
"There is a range of oral healthcare and dental services that are medically necessary for patients to receive cancer treatments and then there are procedures that are needed to help them regain basic human functions after treatment, like speaking, chewing, swallowing,” Stout explained. “Imagine having part of your jaw removed, successfully taking out the cancer, but having to pay thousands of dollars out of your pocket to have a surgery or prosthetic device so that you can talk and eat again.”
Based on claims data from commercial insurers, Stout notes that up to 40% of basic oral health services are denied coverage by commercial payers, and up to 70% of reconstructive surgeries are denied coverage.
Stout briefed the West Virginia Legislature's Joint Committee on Health in this year's legislative session to provide education to lawmakers about this issue as they considered HB 4956. The bill passed both Houses but failed to be reconciled due to last minute amendments.
“The financial impact is significant, but the negative impact on a person's function over the rest of their life is nearly immeasurable,” she said. “This is an issue of great importance in West Virginia, as our rates of oral, esophageal and lung cancers are high, suggesting that the financial and disability burden is widespread.”
Stout is a member of the WVU Cancer Institute and holds a dual appointment in the Department of Cancer Prevention and Control and serves as associate director of the Survivorship Program. In 2022, she was selected to serve as a WVU Bridge Faculty Fellow. The WVU Bridge Initiative for Science and Technology Policy, Leadership and Communications provides researchers with mentored training to translate their work to inform policy and policymakers.
