Thanks for the posts guys.
It's good to hear that Medicare paid for proton treatment
after a prostatectomy.
When I call Medicare or my Medicare Advantage company,
the customer service people were no help when I ask them if they will pay for
proton therapy after a prostatectomy.
And there is no way to get through to the decision makers. Customers aren’t allowed to talk to them.
All they would tell me was to have my doctor ask for an authorization
for the procedure. That means I have to
get coverage from the insurance company first, before the doctor can ask for authorization. My decision as to whether I want to change my
insurance to their company is predicated on if they give coverage for the
protons. So I’m in a catch 22.
I shouldn’t have to pay for coverage from an insurance
company, so that my doctor can apply for proton therapy authorization, just so
I can find out if a company will provide coverage. That’s crazy.
I think some insurance companies “drag their feet” by
first denying authorization (like my insurance company did), so they can save
money. But they might give authorization
later if the patient appeals the process.
That “foot dragging” should be illegal…especially since Medicare apparently
approves proton therapy after a prostatectomy (from what Dutch said). I called Procure a few weeks ago, and I think
they said Medicare covers proton therapy, but I don’t remember if I specified
after a prostatectamy.
At this point I will be doing IMRT since my insurance
company covers that. I don’t have time
to appeal the denial.
Thanks 142. What
you say about proton therapy being so precise that it might work against me for
the prostate bed sounds reasonable. I think someone on another thread mentioned
something like that too.
142, how did you find out that your insurance company
would not pay for proton therapy? Did
your doctor have to formally apply for authorization first? Then did you get turned down? What kind of
insurance do you have?
I figure the only way to find out if the proton procedure
is covered with a particular insurance company, without having a doctor apply
formally for authorization, is to ask other people on the forum since asking
Medicare or my insurance company doesn’t seem to work. Insurance companies sure don’t make it easy
to find out.
Post Edited (BobY777) : 4/25/2012 11:45:24 PM (GMT-6)