Insurance For Proton treatment

Humana is likely not willing to pay for proton therapy for my prostate cancer. Is there any way to get them to pay?  Anyone who has an idea, I would like to at least explore this form of treatment.

Humana did pay for my proton treatment, although they really did not want to. I had to go through an arduous 3 month appeal that ended with our state insurance commissioner ordering Humana to provide coverage. As someone else has noted, the ProtonBob website has lots of help to offer with insurance appeals.

I would suggest that if Humana denies coverage, you should appeal. Most proton centers will help you with your appeal. In my case, the IU Health Proton Therapy Center was outstanding in the assistance that they provided me.

Don't let Humana off the hook -- APPEAL!

Steve

I haven't heard of anyone that has suggested that Proton has a better cure rate than other forms of treatment. The claim is that side effects are reduced: Reduced Normal Tissue Toxicity with Proton Therapy

...Jerry

TC-LasVegas said...
Nice post Jerry.
But we really lack comparisons. That fact is that when PBT became available, we had no IMRT or IGRT. But these technologies have heavily reduce side effects. To the point where we argue which is better. I can't answer that question. Neither can the cohort of radiation oncologists.

And with the dollar differential?

The balls in their court to prove it's better.

Tony

And the proton folks are aware of this. During my time at IU Health, I had the opportunity to talk several times with the director of the facility, and among the things we discussed were the future of proton therapy and insurance coverage (he was aware of my insurance battle). There are several trials going on right now designed to hopefully demonstrate the major benefit of proton therapy for prostate patients, i.e. fewer side effects both short and long term. Informally, they will also tell you that their in-house studies show without a doubt that proton therapy has fewer side effects than photon (even with the newer photon techniques). But they recognize the clamor for "official" studies and these are now in progress. Of course, a study of long term side effects naturally takes a long time to complete, so it may be awhile before we know "for sure."

Other interesting studies that are going on now or getting ready to be undertaken is shortening the treatment time in number of days by increasing the daily dosage. Studies are being formulated to look at using 28, 20 and even 5 days (i.e. cyberknife) keeping the dosage to the prostate consistent.

It will be interesting to see how this all plays out.

SkeeterZX22v: I don't know if you are still on this forum but I hope so. Humana is now trying to deny my husband proton therapy for his PC. They claim that they have NEVER approved it for ANYONE. My husband also has medicare and medicare pays for this treatment. But because humana won't approve it, they are blocking us from seeking approval from medicare. I would like to be able to use cases of approval in our appeal to Humana for Proton treatment. If they have approved even one person, then they must give my husband equal opportunity to the treatment. Would you or anyone here be willing to help me get this treatment for my husband, by allowing me to be able to tell Humana, YES! you have approved this treatment for these X number of men! Thank you for your time and trouble.

In 2011 when I was first diagnosed with PC my URO thought that I would be a good candidate for it, but BCBS of Alabama would not cover the cost and considered it still "experimental". I did find out that BCBS in some states did cover the cost in states that had PBT centers like Florida and Indiana. I do not know If Humana does the same thing but it might be a possibility. I followed the BCBS situation very closely here in Alabama as a guy with PC sued and lost his case with BCBS in 2009 for PBT coverage. I also had issues with BCBS covering seeds being done at a well known clinic in Atlanta as they called it out of network, but in GA that same clinic is in network for BCBS in Georgia. If you can not get your insurance to cover PBT you might look into CyberKnife RT. We now have a CK clinic in Birmingham and low and behold BCBS will cover that now too. Looking back if I had the option in 2011 I would have looked very hard at CK for my treatment instead of the RALP I finally choose.

 

Good luck

 

Terry