Dr. Oz spotlights need for insurance coverage

Posted by on Thursday, April 28th, 2016

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

Posted by on Monday, March 23rd, 2015

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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.

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Tennessee & Oklahoma Fight for Proton Therapy

Posted by on Friday, March 20th, 2015

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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.

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ASTRO Releases Proton Therapy Insurance Coverage Policy

Posted by on Friday, June 6th, 2014

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The premier radiation oncology society in the world, the American Society for Radiation Oncologists (ASTRO), has issued a new Model Policy for proton beam therapy (PBT) that details which cancer diagnoses meet ASTRO’s evidence-based standards and should be covered by private insurers and Medicare.  This is a very significant and welcome development that will help us gain insurance coverage for patients that require proton therapy.

All patients at the Provision Center for Proton Therapy are registered on a multi-institutional registry.  ASTRO stated in their new policy “All indications are suitable for Coverage with Evidence Development (CED).  Proton therapy patients should be covered by the insurance carrier as long as the patient is enrolled in either an IRB-approved clinical trial or in a multi-institutional patient registry.  At this time, no indications are deemed inappropriate for CED.”

Developed by leading radiation oncologists and medical physicists, including significant input from expert representatives in proton therapy, this Model Policy supports PBT coverage for appropriate patients and identifies areas where coverage with evidence development and further research are needed.  ASTRO Model Policies are developed to communicate what ASTRO believes are correct insurance coverage policies for radiation oncology.

ASTRO went on to state:  PBT is neither a new nor an experimental technology for treating cancer with radiation. It utilizes proton radiation particles to deliver highly conformal radiation therapy to a specific tumor target area while giving a much lower dose to the normal tissues in the proton beam’s path of entry and exit. PBT’s reduced radiation dose to healthy tissues is attractive because it can reduce side effects for patients, which potentially increases their quality of life.

“Proton beam therapy (PBT) is demonstrating promise in our continuing efforts to improve survival and cure rates for cancer patients while reducing side effects,” said Colleen A.F. Lawton, MD, FASTRO, chair of ASTRO’s Board of Directors. “As the leading experts in radiation oncology, it is important for ASTRO to provide balanced, evidence-based guidance to payers that ensures access to PBT for cancer patients while being judicious stewards of our nation’s and our patients’ financial resources.”

This Model Policy recommends two coverage groups for PBT: 1) patients with specific diagnoses for which PBT has been proven to be effective; and 2) patients with cancer diagnoses where evidence of effectiveness of PBT is still emerging, and therefore coverage with evidence development is recommended for patients if they are enrolled in clinical trials or a multi-institutional registry to collect data and inform consensus on the role of proton therapy.

ASTRO Model Policies are developed to communicate what ASTRO believes are correct coverage policies for radiation oncology. The ASTRO Model Policies do not serve as clinical guidelines, and they are subject to periodic review and revision. The ASTRO Model Policies may be reproduced and distributed, without modification, for noncommercial purposes. ASTRO has previously issued Model Policies on coverage for brachytherapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), and they are available online at www.astro.org/Daily-Practice/Reimbursement/Model-Policies/Model-Policies/.

The PBT Model Policy was approved by ASTRO’s Board of Directors on May 20, 2014, and is available online at www.astro.org/.

ASTRO is the premier radiation oncology society in the world, with more than 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals that specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, the Society is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standards, advancement of science and research, and advocacy.

 

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Tennessee Man Fights for Proton Therapy

Posted by on Friday, March 28th, 2014

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Bryan Massengale, of Dayton, Tennessee, stands on his family’s 100-year-old farm that he borrowed money against in order to get proton therapy treatments for prostate cancer.

 

The Shopper News published an article this week about a Dayton, Tennessee man who went to great lengths to take his health into his own and fight for the cancer treatment he felt was best for him – proton therapy.  Bryan Massengale has been a public school teacher for 30 years in Rhea County and is a bassonist with the Tennessee Wind Symphony.  At his young age, he wanted the most effective and least damaging treatment possible for his prostate cancer.  When faced with the options given to him by doctors, he instead chose proton therapy, but had to borrow  money against his family’s 100-year-old farm to afford treatments.  The insurance he’d been paying into for 30 years of his career refused to pay for proton therapy treatments at the nearest treatment center at the time in Jacksonville, Florida.  Click here to read his compelling story.

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Provision Sets The Record Straight About Proton Therapy

Posted by on Friday, March 21st, 2014

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Provision visited WATE Channel 6 for a one-on-one interview with anchor Lori Tucker.  We discussed proton therapy, what it means for East Tennessee and cleared up some misconceptions about cost and the efficacy of treatments.  The pending legislation that is currently before Tennessee lawmakers was also discussed.  Passage of this legislation would require Tennessee insurers to cover Tennesseans for proton therapy treatments.  As it now stands, if you live in Tennessee and are between the ages of 19 and 64, you are not covered for this unique treatment option.  However, citizens of neighboring states like Georgia, Kentucky, South Carolina, Virginia or Florida, are covered and are traveling to East Tennessee to receive treatments.  Please help us make sure this treatment option is available to all Tennesseans who desperately need it.  Urge Tennessee lawmakers to vote YES on House Bill 264 and Senate Bill 435.  Go to www.capitol.tn.gov to locate your Representative.

 

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Tennessee Has State’s Only Proton Therapy Center . . . But Not For Tennesseans

Posted by on Friday, March 14th, 2014

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News clip from WKRN:   Olympic Gold medalist and Provision Center for Proton Therapy board member Scott Hamilton visited Capitol Hill in Nashville to encourage lawmakers to support insurance coverage of proton therapy.

Did You Know . . .

Proton Therapy is the most advanced form of cancer treatment in the world, and now Tennessee has the Provision Center for Proton Therapy located in Knoxville. Our Tennessee proton center is one of only 14 operational centers in the nation. However, due to decisions by insurance carriers in Tennessee, if you are between the ages of 19 to 64, you are not covered for this unique treatment option. If you live in a neighboring state like Georgia, Kentucky, South Carolina, Virginia or Florida, you are covered and you can come to our center in Tennessee to receive treatment.

Help us make sure that this treatment option is available to ALL Tennesseans that need it.  Call or email your representative today and encourage them to VOTE YES on Senate Bill 435 and House Bill 264.

www.capitol.tn.gov

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