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Proton Beam Therapy-Insurance denying coverage

Jersey_Girl
Posts: 1
Joined: Jan 2012

I was recently diagnosed with Leiomyosarcoma and the only effective lifesaving treatment for my unique case is Proton Beam Therapy. My tumor was attached to the back of my esophagus. Conventional radiation treatment would subject my heart and lungs to a dangerous amount of radiation. We are battling Horizon Blue Cross/Blue Shield. They consider proton therapy investigational. Has anyone gone up against a huge insurance company? My case will be going to an external appeal soon. If it is denied I will have to pay $60,000 for my treatment. This is a very emotional and needless to say stressful experience for me.

megsrn
Posts: 1
Joined: Apr 2012

I'm curious as to your outcome with the insurance. I am battling a very similar situation. Horizon is denying the Proton Beam radiation for a grade 3 glioma. We just got notified that they denied the claim at the first appeal process. Did you have any luck? Thank you. Wishing you the best.

skwunder24
Posts: 2
Joined: Jul 2012

Don't get how insurance cos can deny proton beam coverage. Is your provider helping you fight this? I got proton beam treatment at Boston's Massechusetts General (Mass General) hospital in 1997 - for chondrosarcoma of the skull base. No problem with insurance. So why are they denying you now? Have you talked to an attorney?

skwunder24
Posts: 2
Joined: Jul 2012

Keep fighting. I had proton beam radiation in the 1997 for a chondrosarcom of the skull base thru Boston's Massechusetts General hospital but on the Harvard campus. They have since built a new proton beam radiation center on the Mass General campus. Where are you being treated? Can't your provider help you get coverage? Suggest you go online and see if Mass general is treating your kinda tumor and see what they say about insurance coverage.

Where are they getting this "investigational"? Did you get a lawyer? There's always the pro bono clincs.

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