Kaiser coverage for Proton Therapy?

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leon76
New Member


Date Joined Jun 2009
Total Posts : 2
   Posted 6/25/2009 8:12 PM (GMT -7)   
Just diagnosed with prostate cancer (T2a) and would prefer proton therapy but have been told Kaiser Permanente will not cover it as a treatment option. Has anyone had any success getting KP to cover proton treatment?

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/25/2009 8:33 PM (GMT -7)   
Hi Leon,
Proton therapy is very costly. Some insurance have begun dropping it and declaring a least cost alternative (LCA) as available like IMRT, brachytherapy, or tomotherapy. But you might want to talk to the facility that will do it (Loma Linda?) and ask them their experience with KP.

Welcome to HealingWell. This is an awesome site for sharing information and support. Make yourself at home and stay with us. Someone who has encountered this should be along soon.

Tony
 Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


crewa2
Regular Member


Date Joined Jun 2009
Total Posts : 43
   Posted 6/26/2009 4:22 AM (GMT -7)   
Leon,
I was just diagnosed as well and I'm looking into the proton therapy. I was wondering if anyone knows the actual cost of these treatments, I can't seem to find it. It's just doesn't seem right for the insurance company to take a certain treatment off the table because of cost.

CS53
New Member


Date Joined Apr 2009
Total Posts : 19
   Posted 6/26/2009 10:28 AM (GMT -7)   

Some good info. here. Brotherhood Of The Balloon promoting prostate cancer prevention, awareness and proton therapy

They can help you with an appeal to your insurance co. 


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 6/26/2009 11:34 AM (GMT -7)   
I thought I had seen average cost of $58,000+ (2007) for Proton Beam Therapy .... more than twice the cost of any kind of Surgery ... even IMRT.

jim
Age 58, 195lbs, 6'4", 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
Biopsy Nov2008 1 of 12 cores 5%, Gleason 3+3 - Sona showed 140+ cc (110 grams post op) prostate size.
02/03/09 open RRP surgery , Nerve sparing both sides, 1 day in hospital, Day 4 first BM,
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
02/18/09 Cath out, passed a 1cm STONE within hours.
Using pump (Encore) daily since catheter out - working good with 2 rings.
04/01/09 Was Oxalate stone -- usually from kidneys -- X-ray Kidneys @ next PSA).
03/06/09 Started Levitra 20mg rehabbing -> no real effect yet (04/01/09) . (Same for Viagra @ 100mg)
04/01/09 PSA <0.1 (And starting Cialis daily @ 5-10mg) -- 04/19 nocturnals finally starting!

Post Edited (JimStars) : 6/26/2009 12:42:34 PM (GMT-6)


leon76
New Member


Date Joined Jun 2009
Total Posts : 2
   Posted 6/27/2009 7:42 AM (GMT -7)   
I was told my Loma Linda that KP doesn't pay...period. Seems strange since Medicare does! I'm continuing to pursue this through Brotherhood of the Balloon but time is of the essence.

chippers
New Member


Date Joined Jun 2009
Total Posts : 5
   Posted 6/28/2009 5:09 PM (GMT -7)   
Just a couple of comments about proton treatment. First I recommend you read a book by Robert J. Marckini titled "You Can Beat Prostrate Cancer and You Don't Need Surgery to Do It", an absolutely excellent read about the proton process and much more. I recent went through the Da Vinci process but I came close to going the proton route and did considerable research on the topic. The total price I was quoted for the proton process by one of the proton centers was approximately $150,000 compared to roughly $50,000 or $60,000 for the Da Vinci process (don't hold me to these numbers but I believe I am close). The primary reason I was given that some insurance companies are refusing to pay for proton treatment is because they are not seeing appreciably improved results compared to other type of treatments at significantly lower costs. I also heard Medicare currently has the proton process under review to determine if they will continue to paying for that type of treatment - same reasoning! Ultimately I made the decision to go with Da Vinci as plan A and possible radiology as plan B. Meaning if I still had problems after surgery I could still pursue radiology (this includes proton) versus the other way around where radiology would leave scar tissue making surgery a difficult followup option. I will say I was very impressed with what I did see and learn of the proton treatment.

CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 6/29/2009 2:48 PM (GMT -7)   
Greetings, Leon76.  Unfortunately, some insurance companies tend to have a strategy to deny, deny, deny until someone finally says the magic words that get them to approve.  Your doc may have some experience in dealing with this particular company and what they need to do to get it approved.
Sorry you have to be here but trust you will find the best treatment for you.  David
Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 7/1/2009 2:40 PM (GMT -7)   

Leon:

It is true that Kaiser will not cover proton - those men who are 65 usually drop Kaiser, go to Medicare and use AARP as their supplemental.  While it is true that there may be a few insurance companies that do not cover proton, with the BOB support group help, most finally come around.  Just recently BlueCross/BlueShield of Texas, NewMexico,Oklahoma & Illinois were going to drop proton as a coverage.  After study they have decided to let it remain a treatment option and the Med Director of BCBS of Texas said he would lean strongly toward proton treatment if he ever has the need.   It's hard to put a price on quality of life.  Wishing you the best in your search for treatment.

Dutch

 

 


Diagnosed Feb 2001  (Age 65)  Currently 73
PSA 4.8      Gleason 3+3=6      Stage   T2b
Completed Proton Therapy @ Loma Linda - 2001 - No side effects.  My journey is at: http://www.healingwell.com/community/default.aspx?f=35&m=727565
7yr PSA - 0.2
Our responsibility now is to educate men about Pca, PSA and the importance of early detection. 
 
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4168
   Posted 7/2/2009 9:13 AM (GMT -7)   
I have mixed feelings on this subject. Kaiser is one of the best medical institutions in the US that provides both excellent health care and low cost which is what we need in the US today.
My insurance company (Tricare) wouldn't pay for robotic surgery, but would pay for laprascopic. so if I chose that option I would have to pay the difference. I didn't have a problem with that because of the many other benefits that Tricare offers.
IMRT has similar cure rates to Proton, but proton "may" have fewer side affects, so is it worth paying thousands of dollars more? I think any insurance company has the right to not pay for a more expensive treatment unless it shows substantial benefit over a less expensive treatment; proton doesn't fall into this catagory.
If it were your own money would you spend $50,000 more for Proton treatment? I surely wouldn't, but you always have that option available to you.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


engineer55
Regular Member


Date Joined May 2009
Total Posts : 121
   Posted 7/2/2009 10:08 AM (GMT -7)   
Bottom line is this country needs to start a conversation on cost benfits of treatments, I think the proton beam needs to be studied as a research tool, but the cost seems a little over the top on what additional benefits it gives. I really would not expect Kaiser to pay for the proton beam.

That is also why we need to continue to look at the things like HIFU and Cyberknife, sounds like the could be beneficial for the right age group, ones that are looking to buy 10-15 years.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings so we have
scheduled surgery for end of June 09.
Coming up quick.

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