Blue Cross/Blue Shield coverage for SBRT?

I have been told by the insurance person in the CyberKnife clinic I'm planning treatment in that she thinks my federal employee group plan does not cover SBRT for prostate cancer (and she showed me the statement in our benefits literature that SBRT is not "medically necessary"), though the literature of the administrator (Blue Cross/Blue Shield of Montana) specifically states that it does cover SBRT for PCa.  We are waiting for word from the administrator.  Any tips or enlightening war stories?

At the Cleveland Clinic, we were told that 80% of SBRT treatment plans are pre-approved by insurance without question. The remaining 20% are "usually" approved on appeal.

BCBS, fed plan, of Florida covered Proton with no questions. Good luck, I hope that you get the answer you are hoping for. Nothing worse than having to change treatment options because of the insurance company's reluctance to pay. I am pretty sure they took your premiums for all these years without complaint.
Cheers,
Kris

If the SBRT provider agrees to a payment that's lower than the competing treatment, it gets approved ! Same for Proton or anything else....

Mel, it isn't about Medicare as that comes from the federal government for people over age 65. It is about the treatment by the private insurance (BCBS) company. And it all depends on the state, the specific company, network and coverage option. While Medicare coverage is universal, the private companies are oriented to the specific region.

BCBS Medicare Advantage (which only applies with Medicare for those over 65) will vary across the country with costs, networks, coverage etc. Your version may be different in Michigan than my mother-in-law has in Florida.

JockMT doesn't indicate he is on Medicare. Rather, it appears he is in the Federal Employee's health insurance plan indicating to me he is still working. It appears to be an employer sponsored group insurance issue with nothing to do with Medicare.

Lupron Jim:

Thanks for your response. I find this whole thing rather confusing.

I keep thinking that if MediCare covers it, then my BCBSM (Michigan BCBS) must cover it as one would think it covers all that PLUS some stuff.

But, that is not the case, I guess. I remember Allen seemed to indicate that MediCare itself varies via regions.

I just started this new insurance setup on 9/1. Haven't used it yet. First use will be my next set of blood tests -- I see the vampire in one week.

I've already did some investigations on its drug coverage, which is administared by Catamaran (Teacher's pension plan in Michigan).

With my at-work cadillac plan, I was paying $10 for a 3-month supply of generic Casodex. It will be $35. with the new plan. Still...not really bad.

If my PSA behaves this time and a few months later, I'll be on HT vacation, so I might not need to order any of that stuff!

Mel

hrpufnstuff,
Not to steal the thread, I had 6 mo HT beginning 2 mo prior to Proton. Changed profile to show the PSA bump @24 mo and ran out of room.
I am guessing that my nadir is 0.3, glad you are on a downward trend.
Cheers,
Kris