What is Proton Therapy
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Your Insurance Questions Answered

Your Insurance Questions Answered

Some of the most common questions we are asked at the Center deal with insurance coverage and financial aspects of receiving care. In this article we’ll provide answers to many of those questions. It’s important to note that answers can vary widely based on the patient’s cancer type and stage, insurance company and policy, and the state in which the insurance company is based, among others.

What is the financial process people go through when they come to the Center for treatment?

Prior to a consultation at the Center, we review each patient’s insurance benefits and prepare an estimate of their out-of-pocket costs. We review this with the patient during their financial consultation. Sometimes “prior authorization” is requested by the insurance company prior to treatment. If so, we will also request this authorization.

What disease sites are most likely to be covered?

Coverage for childhood cancers and ocular cancers are generally covered by most insurance plans. Sometimes other cancer types receive an initial insurance rejection. When this happens, our dedicated Appeals Coordinator can work to have that rejection overturned, depending on the type of cancer. Because appeals win rates vary so much by cancer type and insurance company, it is easiest to speak to each person individually about their chances of having their insurance denial overturned. 

How often do patients proceed with treatment after an initial denial?

Almost all of our patients opt to pursue treatment despite encountering an initial denial. Our Appeals Coordinator may have options to help get your treatment covered after a denial by your carrier.

Typically, how many claims are initially denied?

Only about 15% of our patients receive an initial denial which we subsequently appeal. 

What percentage of insurance companies tend to cover proton therapy?

In general, all insurances will allow coverage of proton therapy for a selected list of cancer types. The types of cancer which are covered vary widely from insurance to insurance. During your financial consultation, your Patient Navigator will review the criteria that your specific insurance uses to determine coverage with you. This will ensure you are informed of the likelihood of coverage, prior to starting treatment.

How long does an appeal tend to take?

It can take up to 18 months to complete an appeal.

What will a patient’s out-of-pocket cost be?

Depending on the insurance company and the policy, the out-of-pocket cost can vary widely. Our Patient Navigators will estimate each patient’s out-of-pocket cost and present this information to them at their financial consultation.

We hope that these answers addressed the majority of your insurance-related questions. If you have further questions on your case, or have a question not addressed here, please give the Center at call at 206-306-2800.