Monthly Archives

March 2015

Cancer is on the rise…but insurance companies refuse to pay for lifesaving treatments

By | Cancer, Clinical Care, Insurance Coverage, Patient Rights, Prostate Cancer, Proton Therapy, Uncategorized | No Comments

More than one-and-a-half million people were diagnosed with cancer last year even as a promising number of treatments are emerging to help combat the growing epidemic, according to a new cancer report released last week by the American Society of Clinical Oncology

However, access to treatment is being hampered by barriers to insurance coverage for those procedures, and a significant number of people find their insurance does not cover promising treatments at all. Cancer treatment centers are spending an increasing amount of time fighting insurance companies to receive coverage for their patients, and preauthorization requirements have been found toincrease demands on staff time, delay or interrupt patient care, decrease patient satisfaction, and complicate medical decision making,” according to the report.

Proton therapy is a clinically-proven, FDA-approved form of cancer treatment that is not an option for many patients because most private insurers do not provide reimbursement. New methods of delivering this special form of radiation therapy mean that, for most patients, proton therapy does not cost more than traditional radiation treatment. Because of the technology’s ability to direct radiation—in the form of protons—to the exact location of the tumor, treatment can be more effective, and patients experience many fewer side effects.

A bill making its way through the Tennessee Assembly gives doctors and patients the freedom to choose the best cancer regimen, including proton therapy. Today, patients who are not covered by Medicare or are not children are typically excluded.

We’re asking Tennesseans to take action to make proton therapy available to more cancer patients. Please contact your representative or senator this week to tell them to support the Cancer Patient Choice Act. See the Tennessee Cancer Patient Coalition website.

Please urge Tennessee lawmakers to make the right choice for cancer patients. Lives are at stake.

Tennessee & Oklahoma Fight for Proton Therapy

By | Cancer, Insurance Coverage, Patient Rights, Proton Therapy, Uncategorized | No Comments

Tennessee isn’t the only state where proton therapy advocates are busy urging legislators to require insurance companies to pay for the cancer treatment.

In Oklahoma, a similar bill has already passed the House of Representatives, unanimously, and is awaiting vote in the state Senate. Specifically, the Oklahoma legislation would prohibit insurers from requiring a higher standard of evidence for implementation of proton therapy than other cancer therapies, according to this article in The Edmond Sun.

In Tennessee, the proposed bill would provide for equal insurance coverage of proton therapy treatments as is currently available for traditional radiation. Proton therapy has been clinically proven effective in treatment of a variety of cancers including prostate, lung, liver, breast and head and neck cancers.

Although historically thought to cost more than traditional radiation therapy, newer methods allow this special form of radiation to be delivered in concentrated doses so that most patients can receive effective treatment of proton therapy for the same cost and over a shorter period of time.

Medicare covers proton therapy, but in most states private insurers do not. Tennessee and Oklahoma could break new ground by requiring insurers to allow patients and their doctors the option of choosing the best treatment for their disease.

Please visit the Tennessee Cancer Patient Coalition website. We ask that you contact your legislator and pledge support for the Cancer Patient Choice Act. Also, please join our Facebook community and share our message with your friends and family.

Prostate Cancer Survivor Advocates Legislation to Help Others Receive Life-Saving Proton Treatment

By | News | No Comments

If Don Denton had followed the advice of the urologist who diagnosed his prostate cancer in the fall of 2010, his life would have turned out much differently.

And if by some chance he were still alive, he would likely be incontinent, impotent and awaiting the very real possibility of the cancer recurring. In other words, his quality of life would be so dramatically diminished it might hardly seem worth the struggle. But Denton had a lot to live for, and he would be the first to tell you he didn’t like the doctor’s odds. So after hearing the diagnosis and anticipating a gloomy future, he and his wife, Sulynne, began researching options to the treatment the urologist had recommended.

For several weeks they scoured the internet and gathered books and networked with cancer survivors, learning everything they could find on treatment for prostate cancer. Meanwhile, the doctor’s office kept calling, wanting to schedule surgery. Denton kept putting them off. “We did incredible research, but we weren’t daunted and we weren’t praying for a miracle. We always felt God would lead us to the right choice. We just hoped He would make it so obvious we wouldn’t miss it,” Denton says with a smile. Just before Christmas of that year, the couple heard about a Blount County prostate cancer support group. “We thought it would be a good idea to talk with others, and the meeting was going to take place just two minutes from our home in Townsend, so it seemed like a good idea. “What we learned from two of the members just blew us away. They had both had proton treatment, which is non-invasive, painless and allows the patient to lead a normal life while undergoing treatment and afterwards. It sounded too good to be true, but we went home and started researching it.”

Knoxville’s Provision Center for Proton Therapy wasn’t open yet. The nearest proton treatment center was in Jacksonville, Florida. Denton applied there, and several days later on Christmas Eve, he was notified that his insurance company wouldn’t cover the cost of proton therapy. “The insurance company said the treatment was ‘experimental,’ despite the fact that at that time there were nine proton centers open in the US and 14 more under construction or development. Denton said he learned that the treatment was far from experimental. “The concept was developed in 1946, the first patient was treated in 1954, and the FDA approved the treatment and Medicare began covering it in 1988. At the time of my diagnosis, tens of thousands of people worldwide had been cured of cancer through outpatient proton treatment and my insurance company was saying it was experimental. “At that point we were devastated. We were ready to mortgage our home and do whatever else it took to get this treatment. Through Christmas of that year we worked with an attorney on an appeal, and then the center asked that we let them file the first appeal with the insurance company.”

The insurance company finally agreed to pay. Don Denton had the treatment as an outpatient over a period of two months, and in the following week after the end of his treatments, he and his wife enjoyed hiking in the mountains and playing three rounds of golf. Today he is free of cancer and has had no permanent side effects or quality of life issues. Denton’s story has a happy ending, and he wants others diagnosed with prostate and breast cancer, which is also treated with proton therapy, to have a similar outcome.

He has written a book about his experience. “Calming the Storm” is available on Amazon.com. You can also find him on Facebook under that title.

In addition, he’s on the speaker’s circuit at every opportunity, telling others about his experience and urging them to contact legislators in support of a bill now in the General Assembly and co-sponsored by state Rep. Ryan Haynes of Knox County and state Sen. Doug Overbey of Blount County.

The bill will force insurance companies to allow patients and their doctors to determine the best medical treatment, including proton treatment. “We hope everyone will contact their legislators and ask for support of the Cancer Patient Choice Act,” Denton says. “Insurance companies shouldn’t be allowed to deny benefits to cancer patients who chose proton therapy, and that’s exactly what is happening today.”

Read the bill in its entirety HERE

Tennessee Cancer Patient Bill of Rights – Get Involved

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The Tennessee Cancer Patient Coalition is gearing up and needs your support.  Led by prostate cancer survivor Don Denton, the Coalition aims to pass legislation that ensures Tennesseans have the right to choose the best treatment options and that insurance companies cover the treatment.

Tennessee ranks 22nd in cancer incidence rate but 5th in cancer death rates. The most advanced radiation treatment in the world, proton therapy, is available in Tennessee, but because private insurers refuse to provide meaningful coverage, most Tennesseans do NOT have access to it.

Proton therapy should be covered for all commercially insured patients and Tenncare patients just as Medicare patients are covered.

However, since commercial insurers have, in general, refused to cover proton therapy, Senator Overbey and Representative Haynes have filed the “Cancer Patient Choice Act” in the Tennessee legislature which states: “To afford eligible patients the right to choose the form of radiation therapy that their physician determines will result in the best clinical outcome and to further research and facilitate the accumulation of proton treatment data without increasing costs above current IMRT costs, all physician-prescribed proton therapy for the treatment of breast or prostate cancer under a hypo-fractionated protocol as part of a clinical trial or registry must be covered by both the patient’s commercial insurance as an in-network service and by TennCare.”

To read the entire bill, click here.

Proton therapy is neither an investigational nor experimental treatment. Proton therapy was cleared by the FDA in 1988 and Medicare provides broad coverage for most common cancer indications. Most patients between the ages of 19 to 64 are denied proton therapy insurer reimbursement.

As far as we can determine, proton therapy is the only cancer treatment covered broadly by Medicare and not covered by commercial insurance for the same indications. This may be the result of Obamacare, since Obamacare passed on the responsibility of determining what is covered in the Obamacare Exchange Plans to the insurers who provide those plans.

Proton therapy precisely delivers a curative dose of radiation to the tumor, and improves the cancer patient survival rate, spares the surrounding healthy tissue, reduces side effects and secondary malignancies and increases the patient’s quality of life.

The top 10 cancer centers in the United States, including MD Anderson, Mayo Clinic, and Memorial-Sloan Kettering, either have or are developing proton therapy centers. There are 14 operational proton centers in the US, 14 under construction, and 15 under development. Tennessee has one proton center operational (Provision Center for Proton Therapy in East Tennessee), one under construction (St. Jude in Memphis), and one under development (Scott Hamilton Proton Center in Middle Tennessee).

The cost of proton therapy continues to decrease as clinicians realize its unique potential for treating the cancer with far fewer treatments of higher doses; and in many cases today, the cost for proton therapy is less than the cost of other forms of treatment.

Insurance companies are making record profits as they refuse to pay for doctor-prescribed treatments. Since Obamacare became law, the big for-profit insurers are making record profits. Their stock price has more than doubled and in many cases more than tripled. At the same time, there is evidence that, to enhance the bottom line, they have been dumping unprofitable individually insured customers and small-business customers and refusing to pay for physician-prescribed care, including proton therapy.

Please visit the Tennessee Cancer Patient Coalition web site.  We ask that you contact  your legislator and pledge support for the Cancer Patient Choice Act (SB-0902 & HB-1006).  Also, please join our Facebook community and share our message with your friends and family.