Patients & providers must team for insurance fight

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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:

  1. Letter of medical necessity and/or recommendation fo treatment choice from other provider(s)
  2. Peer-to-peer review calls
  3. Individualize appeals
  4. Multiple levels of appeals, including external reviews
  5. Assist with patient appeal/grievance

Here’s what patients can do to help:

  1. File a patient grievance letter (supported by Provision staff)
  2. Conference call with us and your insurer
  3. 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.”

Provision’s “Caring Plate” receives $21,000 donation

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A donation from that L5 Foundation will provide 3,500 meals for cancer patients and their families through the Provision CARES Foundation‘s Caring Plate program.

This week the foundation gave $21,000 to the initiative, which is operated through the Knoxville/Knox County Community Action Commitee‘s Mobile Meals program. Provision CARES launched the program with CAC in 2014 in order to provide patients with healthful, nutritious meals during their cancer treatment. Since then, the Caring Plate has suppled more than 5,600 meals to cancer patients and their families. Patients from the following medical centers qualify for the program: East Tennessee Children’s Hospital, Knoxville Comprehensive Breast Center, Provision Center for Proton Therapy, Provision Radiation Therapy, Tennessee Cancer Specialists and the University of Tennessee Cancer Institute.

“The Provision CARES Foundation is honored that the L5 Foundation believes in our unique partnership with CAC to make The Caring Plate program available to families battling cancer throughout our region,” said Provision CARES Foundation Executive Director Les Fout. “The Caring Plate would not be possible without the L5 Foundation and other generous donors who want to make cancer patients cancer survivors.”

The Provision CARES program helps provide a needed service to the community, said Susan Long, director of CAC’s Office on Aging.

“Working with The Caring Plate just seemed like a natural fit,” she said. “It has always been our goal to grow the Mobile Meals program to serve more people of all ages and needs in our community who need nutritious meals to stay healthy and independent in their homes. Preparing meals for and delivering them to the homes of cancer patients just seemed like an obvious next step, and we were thrilled when Provision CARES brought the idea to us. We are happy to see the program taking off like it has and serving more people throughout Knox and surrounding counties who are fighting this disease.”

The L5 Foundation supports five cancer related causes: breast cancer, prostate cancer, lung Cancer, colon cancer, and childhood malignancies.

Provision CARES Foundation is a not-for-profit foundation formed as a world class cancer-care organization that provides cancer awareness, education, wellness, research and patient assistance for patients, their families, and the public in East Tennessee.

Read full press release here.

Kentucky patients flock to Provision

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A growing number of Kentuckians are coming to Provision Healthcare for cancer treatment and leaving as advocates of proton therapy in their home state.

More than 20 patients from the Bluegrass State have completed treatment at the Provision Center for Proton Therapy, and the state serves as one of the largest sources of patients next to Provision’s home state of Tennessee. Patients have come to receive treatment for prostate, breast and lung cancer and lymphoma and have included two pediatric patients suffering from brain tumors.

Proton therapy, for me, was a wonderful discovery,” said Glenn Ross, owner of Investment His Way in Elizabethtown, Ky. “I would absolutely recommend proton therapy to anyone diagnosed with cancer.”

After completing treatment for prostate cancer in June, Ross returned home determined to spread the word across the state, sending a release out to Rotary clubs statewide and setting up a support group for proton therapy patients. He has three presentations on proton therapy scheduled so far.

He’s joined by Richard Sutherland, a fellow prostate cancer sufferer with whom he played golf—six rounds in seven days—and marveled at the minimal side effects they suffered while in proton therapy.

“I’ve got 15 or more friends who have had surgery or conventional radiation for prostate cancer, and I was aware of all the side effects they experienced,” Sutherland said. “Then I started reading about proton therapy. I contacted about 25 patients who had the treatment, and every one of them had the conviction that they did the right thing. During my treatment I played a lot of golf. I ate a lot of good food. And I had very few side effects.”

Richard Sutherland & Glenn Ross

Sutherland, a principal of Frankfurt-based Stantec Consulting, an engineering firm that designs transportation projects throughout the U.S.—Sutherland oversees its Kentucky projects—said he is also looking for opportunities to spread the word about Provision.

“I’d shout about it from the mountain-tops if I could,” he said. “Proton therapy is just little known among the population.”

Eleven-year-old Emma Ferrell of Winchester, Ky., found proton therapy to be a relief after enduring both regular and high dose rounds of chemotherapy for a brain tumor.

“It was pretty wonderful,” says Linda Ferrell, Emma’s mother. “Emma’s been through quite a bit over the last year. With the treatment at Provision, it was pretty easy. I’m a huge advocate for proton therapy.”

Emma and her mother were able to stay at the local Ronald McDonald house and, when Emma felt up to it, enjoyed trips to the zoo, the mall and a local herb garden.

For Lydia P., the trip Provision Center for Proton Therapy offered hope as her son Philip—after three surgeries and an unsuccessful immunotherapy treatment in Germany—continues his battle with stage 4 brain cancer.

“I prayed and said, ‘It’s got to be quick and it’s got to be covered (by insurance),” she says. “For me, it’s just the hope that he’s going to live and that he’ll have two-thirds less of his brain that’s irradiated.”

And the experience at Provision provided a place of refuge in a most difficult situation, Lydia says.

“It’s unusual that you have a group of people that care so much about the patients,” she says.