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Proton Beam Therapy Claims

Insurance Providers Continue to Challenge Claims for Proton Beam Therapy

Receiving a cancer diagnosis is challenging in and of itself. Learning that your insurance provider will not cover a treatment that researchers, medical professionals, and government agencies alike have deemed a valid and effective treatment is a blow that many do not expect to receive in their lifetimes. Unfortunately, this happens all too often with cancer patients whose doctors recommend proton beam therapy (PBT) treatment.

What is PBT?

Proton beam therapy treatment delivers radiation to tumor tissue in a much more confined way than more conventional radiation therapy treatments. Thus, it allows oncologists to deliver a higher dose of radiation to kill the tumor without damaging surrounding tissue. The result is a more effective cancer treatment with minimal side effects.

Proton beam therapy is particularly helpful in treating children, as the procedure allows doctors to beam protons directly to the tumor without exposing growing or developing tissues to radiation. The therapy is also effective for treating tumors in the following areas of the body:

  • Prostate;
  • Liver;
  • Lung;
  • Brain;
  • Breast;
  • Rectum;
  • Esophagus; and
  • Head and neck.

PBT can also be used to combat skull base sarcomas, pediatric brain tumors, and eye melanomas.

Why Do Insurers Not Support PBT?

As the case of cancer survivor Kate Weissman proves, insurance companies are willing to put profits over patient protection and care. In 2015, when Ms. Weissman was just 30 years old, she was diagnosed with stage IIB cervical cancer. After several treatments and an ongoing battle for her life, her doctors at Massachusetts General Hospital recommended that she undergo proton beam therapy treatment to avoid harm from befalling the organs and tissue surrounding the tumor. In April of 2016, her insurer, United Healthcare, denied coverage for the treatment, claiming it was “investigational, experimental, or unproven.” The company recommended that she undergo the more harmful and significantly cheaper intensity-modulated radiation therapy instead. Fortunately, Ms. Weissman was able to foot the bill for the $95,000 treatment, but many others who find themselves in a similar situation would not be able to.

In short, the $95,000 price tag is what is preventing insurers from covering proton beam therapy.  

What Are Your Options?

If your insurer recently denied you coverage for a procedure that could potentially save your life, do not give up. Our attorneys at Kantor & Kantor LLP are prepared to pick apart the denial, your insurance policy, and the insurer’s reasoning and fight on your behalf for the coverage you deserve. Contact our law firm to speak with an associate today, or contact us online.


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