Did Medicare pay for your proton therapy to pelvic bed after prostatectamy ?

Bob,

They should cover IMRT/IGRT for adjuvant radiation therapy after a RP. Get a top, experienced radition oncologist with the latest equipment (e.g. Varian RapidArc, etc.). That would be a good choice (I think better than proton), if you need adjuvant radiation for positive margins.

P.S. Unfortunately, welcome to our corner of the world. Ask plenty of questions. Lots of good folks here willing to help. It will help others respond better if you can post your stats in your signature.

Bob:

There are many, many men who have had proton for adjuvant treatment after surgery and alot of them had their treatment paid for by Medicare.    Go to protonbob.com and about halfway down home page is email address to get info from patients.  Good luck

Dutch 

 

Thanks for the posts guys.

 

It's good to hear that Medicare paid for proton treatment after a prostatectomy. 

 

When I call Medicare or my Medicare Advantage company, the customer service people were no help when I ask them if they will pay for proton therapy after a prostatectomy.  And there is no way to get through to the decision makers.  Customers aren’t allowed to talk to them.

 

All they would tell me was to have my doctor ask for an authorization for the procedure.  That means I have to get coverage from the insurance company first, before the doctor can ask for authorization.  My decision as to whether I want to change my insurance to their company is predicated on if they give coverage for the protons.  So I’m in a catch 22. 

 

I shouldn’t have to pay for coverage from an insurance company, so that my doctor can apply for proton therapy authorization, just so I can find out if a company will provide coverage.  That’s crazy.

 

I think some insurance companies “drag their feet” by first denying authorization (like my insurance company did), so they can save money.  But they might give authorization later if the patient appeals the process.  That “foot dragging” should be illegal…especially since Medicare apparently approves proton therapy after a prostatectomy (from what Dutch said).  I called Procure a few weeks ago, and I think they said Medicare covers proton therapy, but I don’t remember if I specified after a prostatectamy.

 

At this point I will be doing IMRT since my insurance company covers that.  I don’t have time to appeal the denial.

 

Thanks 142.  What you say about proton therapy being so precise that it might work against me for the prostate bed sounds reasonable. I think someone on another thread mentioned something like that too.

 

142, how did you find out that your insurance company would not pay for proton therapy?  Did your doctor have to formally apply for authorization first?  Then did you get turned down? What kind of insurance do you have?

 

I figure the only way to find out if the proton procedure is covered with a particular insurance company, without having a doctor apply formally for authorization, is to ask other people on the forum since asking Medicare or my insurance company doesn’t seem to work.  Insurance companies sure don’t make it easy to find out.

Post Edited (BobY777) : 4/25/2012 11:45:24 PM (GMT-6)

I for one am glad that Medicare and some insurance companies are dragging their feet on some costly procedures that have not shown any more benefits than standard lower cost treatments. Unless they continue to do so medical cost and insurance premiums will have risen to the point that none of us will be able to afford them. Medicare will be in the red by 2016 and I plan to be using it long after that, so I and all of us should have a major interest in keeping it solvent. No one has the right to expect that someone else should pay for a more costly unproven treatment just because they want it. If someone feels that strongly about Proton for SRT then they should fork out the additional costs ($45,000) out of their own pocket. Unless we all start to refuse unneccessary costly scans like bone and CT for low risk patients we will lose everything.
There is absolutely no available evidence that Proton for SRT is more effective than the much less costly IMRT.
JT