HealingWell
Search Close Search
☰

Kaiser coverage for Proton Therapy?

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 6/26/2009 3:12 AM (GMT 0)
Just diagnosed with prostate cancer (T2a) and would prefer proton therapy but have been told Kaiser Permanente will not cover it as a treatment option. Has anyone had any success getting KP to cover proton treatment?
Posted 6/26/2009 3:33 AM (GMT 0)
Hi Leon,
Proton therapy is very costly. Some insurance have begun dropping it and declaring a least cost alternative (LCA) as available like IMRT, brachytherapy, or tomotherapy. But you might want to talk to the facility that will do it (Loma Linda?) and ask them their experience with KP.

Welcome to HealingWell. This is an awesome site for sharing information and support. Make yourself at home and stay with us. Someone who has encountered this should be along soon.

Tony
Posted 6/26/2009 11:22 AM (GMT 0)
Leon,
I was just diagnosed as well and I'm looking into the proton therapy. I was wondering if anyone knows the actual cost of these treatments, I can't seem to find it. It's just doesn't seem right for the insurance company to take a certain treatment off the table because of cost.
Posted 6/26/2009 5:28 PM (GMT 0)

Some good info. here. Brotherhood Of The Balloon promoting prostate cancer prevention, awareness and proton therapy

They can help you with an appeal to your insurance co. 

Posted 6/26/2009 6:34 PM (GMT 0)
I thought I had seen average cost of $58,000+ (2007) for Proton Beam Therapy .... more than twice the cost of any kind of Surgery ... even IMRT.

jim
Posted 6/27/2009 2:42 PM (GMT 0)
I was told my Loma Linda that KP doesn't pay...period. Seems strange since Medicare does! I'm continuing to pursue this through Brotherhood of the Balloon but time is of the essence.
Posted 6/29/2009 12:09 AM (GMT 0)
Just a couple of comments about proton treatment. First I recommend you read a book by Robert J. Marckini titled "You Can Beat Prostrate Cancer and You Don't Need Surgery to Do It", an absolutely excellent read about the proton process and much more. I recent went through the Da Vinci process but I came close to going the proton route and did considerable research on the topic. The total price I was quoted for the proton process by one of the proton centers was approximately $150,000 compared to roughly $50,000 or $60,000 for the Da Vinci process (don't hold me to these numbers but I believe I am close). The primary reason I was given that some insurance companies are refusing to pay for proton treatment is because they are not seeing appreciably improved results compared to other type of treatments at significantly lower costs. I also heard Medicare currently has the proton process under review to determine if they will continue to paying for that type of treatment - same reasoning! Ultimately I made the decision to go with Da Vinci as plan A and possible radiology as plan B. Meaning if I still had problems after surgery I could still pursue radiology (this includes proton) versus the other way around where radiology would leave scar tissue making surgery a difficult followup option. I will say I was very impressed with what I did see and learn of the proton treatment.
Posted 6/29/2009 9:48 PM (GMT 0)
Greetings, Leon76.  Unfortunately, some insurance companies tend to have a strategy to deny, deny, deny until someone finally says the magic words that get them to approve.  Your doc may have some experience in dealing with this particular company and what they need to do to get it approved.

Sorry you have to be here but trust you will find the best treatment for you.  David

Posted 7/1/2009 9:40 PM (GMT 0)

Leon:

It is true that Kaiser will not cover proton - those men who are 65 usually drop Kaiser, go to Medicare and use AARP as their supplemental.  While it is true that there may be a few insurance companies that do not cover proton, with the BOB support group help, most finally come around.  Just recently BlueCross/BlueShield of Texas, NewMexico,Oklahoma & Illinois were going to drop proton as a coverage.  After study they have decided to let it remain a treatment option and the Med Director of BCBS of Texas said he would lean strongly toward proton treatment if he ever has the need.   It's hard to put a price on quality of life.  Wishing you the best in your search for treatment.

Dutch

Posted 7/2/2009 4:13 PM (GMT 0)
I have mixed feelings on this subject. Kaiser is one of the best medical institutions in the US that provides both excellent health care and low cost which is what we need in the US today.
My insurance company (Tricare) wouldn't pay for robotic surgery, but would pay for laprascopic. so if I chose that option I would have to pay the difference. I didn't have a problem with that because of the many other benefits that Tricare offers.
IMRT has similar cure rates to Proton, but proton "may" have fewer side affects, so is it worth paying thousands of dollars more? I think any insurance company has the right to not pay for a more expensive treatment unless it shows substantial benefit over a less expensive treatment; proton doesn't fall into this catagory.
If it were your own money would you spend $50,000 more for Proton treatment? I surely wouldn't, but you always have that option available to you.
JohnT
Posted 7/2/2009 5:08 PM (GMT 0)
Bottom line is this country needs to start a conversation on cost benfits of treatments, I think the proton beam needs to be studied as a research tool, but the cost seems a little over the top on what additional benefits it gives. I really would not expect Kaiser to pay for the proton beam.

That is also why we need to continue to look at the things like HIFU and Cyberknife, sounds like the could be beneficial for the right age group, ones that are looking to buy 10-15 years.
✚ New Topic ✚ Reply