Dr. Oz spotlights need for insurance coverage

Posted by on Thursday, April 28th, 2016


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.

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Patient waits it out for proton therapy

Posted by on Tuesday, April 19th, 2016


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.

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