Monthly Archives

April 2016

Dr. Oz spotlights need for insurance coverage

By | Cancer, Dr. Allen Meek, Insurance Coverage, Legislation, Patient Rights, Patient Stories, Uncategorized | No Comments

CLICK HERE to watch the segment.

Nearly five years ago, 32-year-old Lindsay Rumberger was diagnosed with epithelioid hemangioendothelioma, a long name for a rare cancer that had originated in her liver and metastasized to her lungs. She underwent chemotherapy, but when a tumor close to her spine showed signs of growth, radiation was part of the recommended course. Because conventional radiation treatment threatened to cause peripheral damage to this most sensitive part of the body, her doctors recommended proton therapy instead. However, the insurance provider disagreed, calling the treatment “experimental” and refused coverage. Read More

Patient waits it out for proton therapy

By | Cancer, Dr. Marcio Fagundes, Patient Experience, Patient Stories, Prostate Cancer, Proton Ambassadors, Proton Therapy, Uncategorized | No Comments

When Jacques René Sirois was diagnosed with prostate cancer back in 2014, he knew what he wanted, and he didn’t mind waiting for it.

“I’m not a surgery type of person,” says Sirois, of Franklin, Tenn. For good reason. His brother, diagnosed at 56 with prostate cancer, had undergone a prostatectomy.

“He had surgery—I remember the pain he went through. He’s still suffering the effects at 64,” he says. “Another gentleman I know had radiation. He’s a total mess now.”

Then he met someone who had received proton therapy at the U.S.’s first treatment center in Loma Linda, Calif., and Sirois began looking into the option.

At his doctor’s office, the nurse practitioner offered a range of treatment alternatives, but proton therapy wasn’t on the list. His doctor mentioned it dismissively, because there is no treatment center there.

But Sirois had already found Provision Center for Proton Therapy himself, met with Dr. Marcio Fagundes and made his decision.

“After the consult I said, ‘I know what it’s going to be,’” Sirois says.

His insurance, Cigna, disagreed, denying coverage for proton therapy. He was 64. So Sirois decided to wait for Medicare, taking hormone therapy in hopes of keeping the cancer at bay until then. The plan worked. His PSA level went down, and he was able to wait until insurance kicked in, and he could travel to Knoxville.

But he didn’t wait to spread the good word about proton therapy. Sirois says two patients have come to Provision for cancer treatment on his recommendation, while another sought proton therapy treatment at a different center. And when he finally was able do the treatment himself, all lived up to his expectations.

He traveled from Franklin, a town just outside of Nashville, each week alone for treatment. But at Provision, he says, gesturing toward the lobby, “you’re not going to sit here by yourself.” He’s found the same level of hospitality among the Provision staff, which has made the stretches he’s away from home a little easier, he says.

“I am just amazed at the bedside manners,” Sirois says. “It’s from the minute I walk in to the minute I walk out.”

His friends at home didn’t forget him, though. They sent a Teddy bear, dubbed “Illie Willie,” along to keep him company. Each treatment Sirois hangs onto Illie instead instead of the rubber ring patients typically clutch while the protons do their work. During the day he hangs out with another bear brought by Sharon Hall, Provision hospitality coordinator.

“There have been nothing but positive things coming here,” he says.

Down but not out—fight for proton therapy continues

By | Cancer, Insurance Coverage, Legislation, Proton Therapy, Tennessee, Uncategorized | No Comments

It was a promising year for legislation that would nudge insurance companies toward coverage of proton therapy for cancer patients.

However, after two bills promoting commercial payment for proton therapy were tabled in Tennessee House of Representatives committees, it’s the third year such bills have met with the same result. In both cases the House committees failed to take up a vote on the measures, leaving them to essentially die on the vine—at least for this legislative year.

While the measures didn’t pass, there were some positives takeaways. The bills were proposed by legislators themselves and had grassroots support. This showed that local awareness of proton therapy is growing and that our legislators are increasingly viewing it as an important cancer treatment option.

We encourage patients and their families to connect with their legislators, whatever the state, to promote the importance of proton therapy and encourage insurance coverage. A bill promoting the use of proton therapy passed in the Oklahoma state legislature last year and this year a proton therapy measure was proposed in Virginia, in addition to the two in Tennessee.

But legislation is not the only tactic for combatting the problem of insurance coverage.

Provision will work to increase public awareness of insurance companies’ failure to widely cover proton therapy for cancer patients—resulting in some patients seeking alternative treatments with undesirable side effects or scrambling to pay the costs out of their own pockets, according to Scott Warwick, vice president of program development and strategic initiatives for Provision Center for Proton Therapy

“We believe when the public realizes that insurance companies are preventing patients from getting the medical care they need, they will help put direct pressure on insurance companies to pay for proton therapy,” he says.

Another strategy is for companies that are self-insured is to request providers add proton therapy coverage to their policies. Provision, for example, covers its own employees for proton therapy through Cigna. Seventy percent of people covered for health care under commercial insurance are included in these company-funded plans, affording the opportunity for proton therapy to be included in the policy at little extra cost.

At the same time, he says, Provision will continue, as it has for the past several years, to dialogue with insurance companies in an effort to “come to agreement on reasonable coverage terms for proton therapy.”

Thanks to all the patients who contacted our legislators this year to urge passage of the bills. With a consolidated effort by continued patient support your voice will be heard. Please voice your opinion to legislators and your insurance companies in support of proton therapy, a life-changing cancer treatment.

Provision Chairman & patient were college classmates

By | Cancer, Dr. Marcio Fagundes, Knoxville, Patient Experience, Patient Stories, Prostate Cancer, Proton Therapy, Survivors, Terry Douglass, Uncategorized | No Comments

As Paul Dyer scanned through a coffee table book about Knoxville while waiting in the lobby at Provision Center for Proton Therapy for his treatment, a name suddenly seized his attention: Terry Douglass.

The chapter was about Provision and outlined the role Douglass, chairman and founder, played in its start-up as well as the prior successful start-up and sale of CTI. That company, now owned by Siemens, developed and brought positron emission tomography, or PET scanning, to the healthcare market.

“I knew it had to be the same Terry Douglass,” Dyer says.

More than 50 years before, the two were classmates at the University of Tennessee’s School of Engineering—Douglass in electrical engineering, Dyer in the mechanical engineering program.

Dyer says he had no clue Douglass was the entrepreneur behind Provision before he traveled from Eagleville, a small town in middle Tennessee, for treatment. At a recent reunion with some fellow classmates, he says, he had learned about Douglass’s involvement with CTI.

“We always knew he would do something important,” Dyer says.

Although the two were in different programs, they had a couple of classes together and hung out with the same crowd.

“I always had the sinful hope that he wouldn’t do so well on tests,” Dyer says, jokingly. “He scored almost perfect and the professor would not give a curve.”

After college, the two went their separate ways—Dyer going to work for DuPont and retiring a few years ago to the family farm, Douglass going to a position at Oak Ridge National Laboratory, the first in a series of steps toward the launch of CTI. They had not seen each other since.

When he was diagnosed with prostate cancer, it was Dyer’s primary care doctor who suggested proton therapy. He found Provision online, set up an appointment and was duly impressed with the responsiveness of the staff and, especially, Dr. Marcio Fagundes, who called his doctor and then Dyer personally as he was considering whether to choose proton therapy. In the end, Dyer and his wife decided to travel the 380 round trip miles each day to Provision for treatment.

The Friday before Dyer’s graduation, he and Douglass were reunited, posing for a photo and chatting for a few minutes about old times.

“I am so blessed that people like Terry have had ideas like PET and proton therapy and that, somehow, he has pulled all this together and made it a world-class facility,” Dyer says.

For Douglass, it was a gratifying reconnection.

“It is very rewarding and humbling to know that something of which I have been a part is impacting the lives of those whom I knew decades ago,” he says. “We never know how what we do impacts others, and we should all be thankful and blessed that we can be a part of something unique that changes lives and patient care for the better.”