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Patient Rights

Patients & providers must team for insurance fight

By | Insurance Coverage, Patient Rights, Uncategorized | No Comments

Qualifying for proton therapy is one thing. Paying for it can be another.

Although Medicare covers proton therapy for seniors with cancer and most private policies provide coverage for children, patients who fall in between can have difficulty getting payment from their private insurers.

There are things that patients can do to help. All incoming patients to Provision Center for Proton Therapy receive a fact sheet (click here to download fact sheet) to give them tools to fight for coverage of proton therapy—for themselves and for others.

 

“We believe it’s important for patients to be empowered to fight for the coverage they deserve when facing a cancer diagnosis,” says Rhonda Turner, manager of financial services at Provision Center for Proton Therapy. “We know that we won’t always win every case, but together we can improve our chances for success.”

Here’s what financial services does to assist in the insurance process:

  1. Letter of medical necessity and/or recommendation fo treatment choice from other provider(s)
  2. Peer-to-peer review calls
  3. Individualize appeals
  4. Multiple levels of appeals, including external reviews
  5. Assist with patient appeal/grievance

Here’s what patients can do to help:

  1. File a patient grievance letter (supported by Provision staff)
  2. Conference call with us and your insurer
  3. Contact your employer—some employers can override insurance coverage decision

Provision patients can also help in the fight for others, writing letters to insurance providers, sharing their stories on social media and contacting elected officials.

“Public pressure is the best way to ensure coverage of proton therapy in the future,” Turner says. “Nobody can communicate the need for proton therapy better than those who are being denied access to it.”

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

Provision responds to Biden push for cancer cure

By | Breast Cancer, Cancer, Innovation, lung cancer, Patient Rights, Prostate Cancer, Proton Therapy, research, Scott Hamilton, Screening, side effects, surgery, Survivors, Technology, Uncategorized | No Comments

Vice President Joe Biden’s recent commitment to lead a “moonshot” toward a cancer cure promises to deal a blow to the disease that has become the leading killer in the United States.

The initiative, kicked off last week, commits to bringing together a combination of therapies with “innovations in data and technology” to create treatment options that are ready for prime time—with the goal of making “a decade worth of advances in five years.”

Here at Provision, we couldn’t agree more. It’s something we work toward every day.

We believe the solution to a cancer cure is a combination of early detection along with both currently available and up-and-coming therapies that have the power to transform cancer treatment as we know it.

Here’s our view of a cancer-free future.

Ninety percent of cancer is treatable when detected early. If those at risk for a variety of cancers—particularly the big three: prostate, breast and lung—were screened appropriately, many of the cancer deaths we now mourn could be prevented.

For those who test positive for cancer, the healthcare system needs to, through research as well as financial support via insurance coverage, move toward treatments that kill the cancer but spare the patient and sustain quality of life.

Today, surgery, radiation and chemotherapy in various measures and combinations are the typical recipe for cancer care. All three of these remedies carry their own risks, from that of infection and complications in surgery to the collateral damage of radiation to the harsh toll chemotherapy takes on the entire body. Truly, the cure can be worse than the disease.

Here’s our vision of the future:

First, conventional radiation and most surgery should be replaced by proton therapy. Proton therapy is a proven, FDA-approved treatment option for those diagnosed with localized cancer such as found in the prostate, breast or brain. This non-invasive treatment reduces the side effects caused by conventional radiation therapy and surgery. A growing number of proton therapy centers are making this world-class option available to patients across the globe. We support their research in developing the best treatment plans and clinically demonstrating proton therapy’s effectiveness.

Second, immunotherapy offers the promise of a future without chemotherapy. By using the body’s own disease-fighting system to eradicate cancer, it eliminates the toxic, debilitating side effects now experienced by chemo patients and better prevents spread of the disease. Research should be dedicated to bringing this unique treatment to everyday application for cancers that now require chemotherapy.

And serious, strategic investment should be made in cancer prevention by encouraging healthy lifestyle choice and reducing environmental risks.

As Biden has said, for too long research has been stuck in silos, focused on narrow investigative tracks and lacking a clear, comprehensive, thoughtful vision that could actually move the needle on cancer mortality. Treatment is too often dictated by the financial interest of the health care industry rather than public and personal health priorities. Patients are too often relegated into the role of bystanders rather than active participants in their care.

We rejoice in the government’s fresh approach to this growing crisis. We are encouraged by the vice president’s willingness to seek the best answers to a problem that has touched his life and ours. We believe the answer is within reach—and we want to be a part of the solution. As Provision’s own ice-skating, cancer-surviving spokesman Scott Hamilton so eloquently puts it: “We want to help turn cancer upside down!”

 

 

Tennessee legislator leads charge to change laws for coverage

By | Insurance Coverage, Patient Rights, Patient Stories, Tennessee, Uncategorized | No Comments

Tennessee Senator Doug Overbey first learned about proton therapy several years ago when a church member had to travel out of state to receive the cancer treatment—and then mortgage her house to pay for it.

Today, Tennesseans can receive proton therapy closer to home, thanks to the Provision Center for Proton Therapy in Knoxville. But, unfortunately, some are still faced with paying for it themselves or going without.

For the past two years, Overbey has been fighting this inequity in the Tennessee General Assembly, and he’s not stopping now.

In a television interview with WATE “On Your Side” reporter Halley Holloway, Overbey pledged to continue fighting for insurance coverage that often eludes patients between ages 18 and 65 who are diagnosed with cancer. The interview was posted on the news station’s website along with a story about Tennessee breast cancer patient Lou Lovingood, whose Blue Cross Blue Shield insurance carrier had denied her claim for proton therapy treatment three times. Lovingood received treatment at Provision, where she was the center’s 500th patient.

Proton therapy has been used for treatment of cancer since the 1950s and approved for coverage by Medicare as well as by most insurers for pediatric cases since the early 1990s, when the modality became available at mainstream healthcare facilities. Overbey has supported two bills in the state legislature that would pave the way for private insurance to cover proton therapy for everyone—measures strongly opposed by insurance companies, particularly Blue Cross Blue Shield of Tennessee. Read More

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.