Insurance Authorizations in Pediatric Disorders of Gut-Brain Interaction Treated With Auricular Neuromodulation: A...

Auricular percutaneous electrical nerve field stimulation (PENFS) is a Food and Drug Administration-approved treatment for functional abdominal pain associated with irritable bowel syndrome and functional dyspepsia. Because PENFS is relatively new, insurance coverage has been inconsistent, with patients experiencing denials or delays in authorization. Thus, we aimed to evaluate insurance authorizations and their influence on outcomes in children with disorders of gut-brain interaction (DGBI) who undergo PENFS.

We reviewed charts of patients with DGBI aged seven to 21 years receiving PENFS at the DGBI Clinic at Cincinnati Children's Hospital from 2017 to 2024. We computed the duration of insurance authorization steps to treatment, divided the cohort into early and delayed authorization groups, and assessed outcomes on the basis of collected validated questionnaire scores.

Among 309 patients (median age 15 years; 78% female; 90% Caucasian), 75% had private and 25% public insurance. Prior authorization (PA) was not required in 55% of cases, whereas 18% were initially approved and 27% denied. Overall, 70% of patients were approved and 30% were denied after completion of the insurance process. Private insurers were more likely to deny PA than public ones (29% vs 21%, p = 0.003). Kaplan-Meier analysis showed significantly longer time to approval for those denied coverage (p < 0.001). Outcomes based on validated questionnaire scores did not differ between early and delayed insurance groups at the final PENFS placement visit (p > 0.05 for all).

Private insurance denials are significantly more common than public, creating disparity in availability of PENFS treatment for this group of patients with complex conditions. The timing of insurance denials can lead to delayed treatment, providing less than optimal patient care.