For more than a decade, using What Insurance Companies Cover Proton Therapy as a weapon against prostate cancer has been seen as a promising proposition. However, proton beam radiation is waging a battle in a new field: the politics of insurance payments.
Proton beam economics boils down to one word: expensive. In the summer of 2014, Indiana University’s Proton Center for Health announced that it would close within a year, costing millions of dollars in the 10 years since it opened.
What Insurance Companies Cover Proton Therapy
- 1 What Insurance Companies Cover Proton Therapy
- 2 What Is Proton Therapy?
- 3 What Types of Cancer Does Proton Therapy Use to Treat?
- 4 Does Insurance Cover Proton Therapy?
- 5 Cost & Coverage Options for Proton Therapy Cancer Treatment
- 6 How Much Does Proton Therapy Cancer Treatment Cost?
- 7 Payment & Insurance Coverage Options For Proton Therapy
- 8 How Much Does Proton Therapy Cost Without Insurance?
- 9 Insurance Coverage Assistance
- 10 Cost of Proton Therapy and Accepted Insurance Providers
- 11 How Does Proton Therapy Cost Compare To Others?
- 12 What is the average cost of proton therapy?
- 13 How do you qualify for proton therapy?
- 14 Does most insurance cover proton therapy?
- 15 What are the disadvantages of proton therapy?
- 16 How many treatments do you need for proton therapy?
The fact is that building and equipping a What Insurance Companies Cover Proton Therapy center costs up to $200 million. There are currently 14 centers in the U.S., with construction plans for more in the works.
These centers depend on payment for the care they provide. Scientific data support the scope of proton therapy for certain cancers affecting the spinal cord, eye (such as uveal melanoma), and brain.
Because proton beam has less “scatter” than traditional photon beam radiation, it is effective in controlling this cancer while minimizing the side effects of treatment.
In addition to Medicare, private insurance companies such as Blue Cross, Aetna, United Healthcare and Cigna offer coverage for this cancer but some of it is relatively rare. In other words, proton beam facilities seek to treat more common cancers.
Prostate cancer is the most common internal cancer among men, with more than 230,000 new cases diagnosed each year in the U.S. About one-third of patients considered candidates for whole-gland (radical) treatment have some form of radiation.
However, side effects can include sexual dysfunction, bladder or rectal problems, and secondary cancers that appear years later.
Patients perceive What Insurance Companies Cover Proton Therapy as a better radiation option because it appears to have a lower side-effect profile, but insurance companies have not found conclusive side-effect data.
More importantly, they really care about superior cancer control. This is another area where the proton beam has yet to prove itself to the major insurance companies and looks set to lose the battle.
Published data on the efficacy of proton beam as a prostate cancer treatment have not demonstrated a significant advantage over other forms of radiation, including Intensity Modulated Radiation Therapy (IMRT).
But Medicare reimbursement rates for prostate cancer therapy are much higher. The reluctance of private insurance to cover the additional costs is understandable, and the refusal to cover the proton beam seems contagious as private payers are pulling out of coverage one after another.
This policy reversal creates a real research dilemma. Take the case of the University of Pennsylvania clinical trial, which was designed to compare prostate cancer photons vs proton beam radiation in hopes of showing whether proton beams are really better at all things.
With the aim of enrolling 400 patients who would be randomized to receive a What Insurance Companies Cover Proton Therapy or other treatment, the costs of conducting the treatment and follow-up were enormous. Without payment, this study is unlikely to reach completion in the near future.
One other obstacle also affected enrollment: males who wanted proton beams might refuse to be selected for the comparison study group, simply because they already believed protons were preferable.
The point is, without money, the proton beam cannot hope to prove itself worthy of replacement; and without proving it yourself, reimbursement is unlikely to be provided at the level required to maintain existing centers as well as centers that are developing.
If you have been diagnosed with cancer, it is very important that you receive the treatment you need based on your doctor’s recommendations. You and your doctor should decide on your treatment plan, not your insurance company.
If your doctor has prescribed proton therapy, but your insurance company won’t pay for it, we can help. Whether your claim for What Insurance Companies Cover Proton Therapy was recently denied or you’re preparing to appeal a disclaimer of insurance, our attorneys have the experience to fight for your health benefits and the treatment you need.
What Is Proton Therapy?
What Insurance Companies Cover Proton Therapy uses protons to match the shape of a cancerous tumor to deliver a more precise, but increasing dose of radiation while reducing exposure to surrounding healthy tissue. As a result, proton therapy is considered to be just as effective, but safer than traditional radiation in most cases.
What Types of Cancer Does Proton Therapy Use to Treat?
Proton therapy has been found to be successful in treating various types of cancer, including:
- Brain Tumor
- Breast Cancer
- Eye Cancer (Melanoma)
- Head And Neck Tumors
- Lung Cancer
- Prostate Cancer
- Skull Base Tumor
- Spinal Tumor
However, whether What Insurance Companies Cover Proton Therapy is covered for your type of cancer depends on the specific requirements of your health plan.
Does Insurance Cover Proton Therapy?
Proton therapy was first discovered in the early 1900s and was approved by the US Food and Drug Administration (“FDA”) for the treatment of cancer in 1988. However, proton therapy tends to be more expensive than traditional radiation and is still not covered by many insurances.
There are a variety of reasons insurance companies will deny coverage for What Insurance Companies Cover Proton Therapy, including claiming it’s experimental or not medically necessary for your particular cancer diagnosis. Proton therapy may still provide the life-saving treatment you need.
That’s why it’s very important that you consult with a lawyer experienced in dealing with denial of health benefits such as an attorney at DeBofsky Sherman Casciari Reynolds P.C. We can advise you on the specific terms and limitations in your health plan, and how to fight for the cancer treatment coverage you need.
Health Lawyers and ERISA With Records of Getting Canceled Proton Therapy Insurance Refusal
Attorney at DeBofsky Sherman Casciari Reynolds P.C. has a proven track record of getting paid for their clients who are denied medical treatment, including What Insurance Companies Cover Proton Therapy.
Cost & Coverage Options for Proton Therapy Cancer Treatment
Dealing with a cancer diagnosis is quite difficult. We have a dedicated team to help you with paperwork, work with What Insurance Companies Cover Proton Therapy, make a case for your treatment, and even help you with appeals, lightening the burden of dealing with insurance costs and coverage so you can focus on recovering.
How Much Does Proton Therapy Cancer Treatment Cost?
The cost of proton therapy treatment varies according to your insurance provider, condition, medical history, and other factors such as the number of treatments.
Keep in mind that the cost per daily dose of protons may be slightly higher than traditional radiation, but the long-term costs can be much less because patients tend to experience fewer side effects that require treatment or medication.
In fact, recent studies have shown that What Insurance Companies Cover Proton Therapy costs less than other cancer treatment options.
Payment & Insurance Coverage Options For Proton Therapy
While proton beam cancer treatment is covered by Medicare, private insurance coverage varies. Some companies do not reimburse service fees or only cover treatment for certain diagnoses.
If your insurance carrier pays for What Insurance Companies Cover Proton Therapy, patients often incur little or no costs themselves once they are deducted and the maximum annual payment is met.
In this situation, our team of cancer specialists and doctors will work directly with your insurance plan to request treatment clearance by providing appropriate documentation to support the medical needs of the treatment.
How Much Does Proton Therapy Cost Without Insurance?
For those whose insurance does not cover What Insurance Companies Cover Proton Therapy, or Americans and foreign nationals without coverage in the US, we offer a reduced self-payment option.
Insurance Coverage Assistance
We have a dedicated team of patient and physician representatives who will work with any What Insurance Companies Cover Proton Therapy on your behalf to facilitate authorization and reimbursement of treatment costs. They help with:
- Responding to insurance company inquiries
- Write a letter of medical necessity and submit supporting documentation on your behalf
- Participate in peer-to-peer discussions about your treatment
- Provide a comparative care plan as needed
- File an appeal on your behalf if your insurance refuses coverage
- Confirming your eligibility, benefits, deductibles, and co-payments/co-insurance terms
The search for better prostate cancer treatments is a tricky one. Currently, men with early-stage, low-risk cancer are opting for active surveillance in increasing numbers because new genetic evidence suggests that not all prostate cancer will develop into a life-threatening disease.
However, for those patients, who are diagnosed with potentially lethal cancer, their available treatment options are inevitably influenced by economics, both personal and political. Until circumstances change, the patient will not truly experience the freedom of choice.
Cost of Proton Therapy and Accepted Insurance Providers
Offsetting the cost of What Insurance Companies Cover Proton Therapy is a major concern for patients and LLUMC. This is why Proton Treatment Centers accept insurance plans from 250 providers including Medicare and Medicaid.
While most medical insurance companies will consider proton treatment on a case-by-case basis, our financial coordinator will provide further assistance in coordinating this sensitive financial matter. Proton therapy is usually covered by Medicare.
Our finance coordinator can help you work with your insurance company to get authorization. What Insurance Companies Cover Proton Therapy are on hand to assist patients to explore potential relief options. Call our staff at 1-800-PROTONS for financial assistance today!
How Does Proton Therapy Cost Compare To Others?
Used to Treat Cancer?
The long-term costs of patients treated with What Insurance Companies Cover Proton Therapy are significantly less than patients treated with surgery or IMRT.
That’s because proton therapy patients experience fewer side effects and a better quality of life, and it reduces the ongoing medical and social costs associated with those patients.
For the cost of the treatment itself, reimbursement from private health insurance varies depending on the insurance operator and the type of What Insurance Companies Cover Proton Therapy that administers the treatment.
There are different reimbursement rates associated with non-profit, hospital-based, academic medical centers, and freestanding centers.
In some stand-alone proton centers, substitution for protons is about the same replacement rate as in IMRT. Medicare and Medicaid Service Centers reimburse only non-profit medical centers based in hospitals. Loma Linda University Medical Center is one of only three such centers in the United States.
Written input from a doctor can be a valuable resource when filing a refusal. Doctors at selected What Insurance Companies Cover Proton Therapy facilities can help provide important medical documentation.
This is often referred to as a “Letter of Medical Need” and explains in detail why proton therapy is the most appropriate treatment available for a cancer patient’s specific condition.
Cancer patients who are uncomfortable with the appeals process sometimes seek the services of a lawyer. Some attorneys specialize in dealing with denial of coverage appeals and this can be a boon to cancer patients and their families.
Lawyers are aware of individual state laws regarding health insurance denial appeals and can ensure that health insurance companies follow their own rules as well as state laws. Health insurance companies will also take denial appeals more seriously once a lawyer is hired.
What is the average cost of proton therapy?
Proton therapy costs range from about $30,000 to $120,000. In contrast, a course of treatment with radiosurgery costs about $8,000-$12,000, Heron said. IMRT (intensity-modulated radiation therapy) costs about $15,000.
How do you qualify for proton therapy?
Particularly good candidates for proton therapy are patients with solid tumors near sensitive organs, such as brain, breast, and lung cancers. While, for recurrent, pediatric, and ocular cancers, proton radiation is viewed as the standard of care.
Does most insurance cover proton therapy?
What Insurance Companies Cover Proton Therapy? Medicare generally covers proton beam therapy. Coverage varies by the insurance company and disease type. Mayo Clinic specialists work with each patient and the health insurance company to determine if proton beam therapy is covered as the recommended treatment.
What are the disadvantages of proton therapy?
Side effects can develop gradually after treatment and might include: Sore, reddened skin around the treatment area that can look and feel like a sunburn. Hair loss in the treatment area. Tiredness or low energy.
How many treatments do you need for proton therapy?
The number of treatment sessions depends on the type and stage of cancer. Sometimes, doctors deliver proton therapy in 1 to 5 proton beam treatments. They generally use larger daily radiation doses for a fewer number of treatments.
Sumber: sperlingprostatecenter.com, californiaprotons.com, protons.com, and debofsky.com