Qualifying for proton therapy is one thing. Paying for it can be another.
Although Medicare covers proton therapy for seniors with cancer and most private policies provide coverage for children, patients who fall in between can have difficulty getting payment from their private insurers.
There are things that patients can do to help. All incoming patients to Provision Center for Proton Therapy receive a fact sheet (click here to download fact sheet) to give them tools to fight for coverage of proton therapy—for themselves and for others.
“We believe it’s important for patients to be empowered to fight for the coverage they deserve when facing a cancer diagnosis,” says Rhonda Turner, manager of financial services at Provision Center for Proton Therapy. “We know that we won’t always win every case, but together we can improve our chances for success.”
Here’s what financial services does to assist in the insurance process:
- Letter of medical necessity and/or recommendation fo treatment choice from other provider(s)
- Peer-to-peer review calls
- Individualize appeals
- Multiple levels of appeals, including external reviews
- Assist with patient appeal/grievance
Here’s what patients can do to help:
- File a patient grievance letter (supported by Provision staff)
- Conference call with us and your insurer
- Contact your employer—some employers can override insurance coverage decision
Provision patients can also help in the fight for others, writing letters to insurance providers, sharing their stories on social media and contacting elected officials.
“Public pressure is the best way to ensure coverage of proton therapy in the future,” Turner says. “Nobody can communicate the need for proton therapy better than those who are being denied access to it.”