Proton Treatment Center as Patient Advocate when Insurance Companies Deny Coverage
Thursday, September 25, 2008
LOMA LINDA, CA- Receiving news that you or a loved one has cancer can be frightening enough, but hearing that your insurance company does not want to pay for treatment can be downright devastating. Across the country, a growing number of patients are appealing coverage denials, enlisting help from doctors, internet research and patient rights advocacy groups. At Loma Linda University Medical Center's James M. Slater, M.D. Proton Treatment and Research Center, doctors and patients are working together to ensure that insurance companies approve proton beam radiation treatment.
Ellen and Paul Hoppe's Medicare Advantage plan, provided by Health Net of California, declined to pay for proton radiation treatments for Paul’s prostate cancer. The denial document said there was no evidence that Mr. Hoppe, 67, would get any added advantage from proton beam cancer therapy which is significantly more expensive than conventional radiation therapy.
The Hoppes, phone-company retirees in California, were convinced that the proton beam therapy offered at Loma Linda University Medical Center's Proton Treatment Center was the best choice for treating Paul's prostate cancer. The Center is the world's first hospital-based Proton Treatment Center for prostate, lung and brain cancers, and since its establishment, has conducted more than 350,000 treatments.
Where conventional radiation therapies could result in unintended damage to healthy tissues and organs causing harmful side effects, proton radiation treatments are noninvasive, precise and increase the likelihood of protecting healthy tissues and organs. Instead of settling for a cancer treatment method with a higher risk of side effects, the Hoppes got backing from Paul's doctor and appealed the case with the insurance company.
The doctor, informed by Loma Linda University Medical Center's Proton Treatment Center's mission “to make man whole” through Christ-centered healing, wrote a six-page letter to the insurance company. Including two pages of research citations, the letter argued the proven track record, efficacy and advantages of proton beam radiation therapy in treating prostate cancer.
In June, Medicare's appeals contractor sided with the Hoppes, stating proton beam therapy qualified for the federal standard of "reasonable and necessary" treatment. Read The Wall Street Journal’s account of the Hoppes’ experience working with Loma Linda University Medical Center’s Proton Treatment Center to appeal their insurance company’s initial denial of coverage for Paul’s proton beam radiation, or watch this video to hear from the Hoppes themselves.
About the James M. Slater, M.D. Proton Treatment and Research Center
The James M. Slater, M.D. Proton Treatment and Research Center is the first hospital-based proton therapy facility in the world. Until 2003, it was the only one in the United States. The pioneering nature of this facility is a testament to how medicine is practiced at Loma Linda University Medical Center and is just one of the many services Loma Linda University Medical Center offers.
About Loma Linda University Medical Center
A globally recognized leader in health care, Loma Linda University Medical Center operates some of the largest clinical programs in the United States in areas such as neonatal care and outpatient surgery and is recognized as the international leader in infant heart transplantation and proton treatments for cancer. Each year, the institution admits more than 33,000 inpatients and serves roughly half a million outpatients.