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Premera and Regence Expand Proton Coverage

Premera and Regence Expand Proton Coverage

SCCA Proton Therapy Center continues to work with our local and national insurance companies to expand member benefit coverage for appropriate patients in need of proton therapy. We are very excited about the following updates to our local Washington healthplan coverage policies.

Premera Blue Cross of Washington has elected to use the “AIM Specialty Health Clinical Appropriateness Guidelines: Radiation Oncology for Proton Beam Radiation Therapy” as their medical coverage policy guidance effective July 1, 2016. In comparison to the previous Premera coverage policy, this new policy expands coverage to all pediatric tumors for patients aged 21 and younger. The new policy also expands coverage for all patients of all ages with primary or metastatic Central Nervous System tumors such as Arteriovenous Malformations or Gliomas (when other treatment options do not limit radiation risk in local critical structures), in addition to the previously covered patients with Chordomas and Chondrosarcomas. 

Regence Blue Shield of Washington and SCCA Proton Therapy Center have reached agreement for participation in the Regence Commercial and Medicare networks. As a component of the agreement, SCCA Proton Therapy Center and Regence agreed to allow Regence members with clinically-localized prostate cancer to be approved for radiation therapy treatment at SCCA Proton Therapy Center as a covered in-network benefit. The Regence clinical coverage policy for prostate cancer remains unchanged for patients who may select other treatment centers which do not meet the cost criteria for medical necessity under the benefit plan. Please contact us directly at info@seattleprotons.org if you have any questions about your coverage or to see if you or your patient with prostate cancer may qualify for coverage of proton therapy.