Proton Therapy Insurance Denial Lawyer

When you have cancer, you know the hope that comes with news of any new option for treatment. And when your doctor comes to you with a therapy that is safe, effective, and backed by decades of scientific research, you jump at what may be your best chance for a complete recovery.

But what happens when your insurance company refuses to pay for what could be lifesaving treatment? Worse yet, you know—even when the insurance company tries to give another excuse—that the reason your claim is being denied is because the company thinks it’s too expensive.

Your insurance company doesn’t have the final say. You have options. Learn more by speaking with a proton therapy insurance denial lawyer from the Law Office of Matthew L. Sharp.

What Is Proton Therapy?

Proton therapy, or proton beam therapy, is a form of cancer treatment. It is radiation therapy that uses protons instead of X-rays. It is more precise than other types of radiation therapy, targeting the tumor directly with less radiation to healthy tissue.

Proton therapy is a painless procedure that allows the majority of patients to go about their normal lives after each session, without painful or debilitating side effects. Any side effects are typically minimal. If present, symptoms are usually limited to redness and soreness at the site, feelings of tiredness, and hair loss in the area of treatment.

The procedure only takes a few minutes (after preparation and positioning), and most patients will complete a five-day-a-week regimen that lasts several weeks or months.

What Are the Benefits of Proton Beam Therapy?

Proton therapy is generally a safer, more precise, and more pain-free cancer treatment option than many other forms of therapy. For certain types of tumors, it is often the best choice to eliminate dangerous cells without inflicting widespread harm on the rest of the body.

Proton beam therapy has the unique advantage of being able to more accurately pinpoint and destroy cancerous cells in the tumor without disturbing nearby cell tissue. This makes it especially useful for treating tumors in sensitive locations like the brain, where important functions like speech and memory can be lost if surrounding tissue is affected by radiation.

It has also proven useful in treating children suffering from various forms of pediatric cancer. Children who are exposed to toxic chemicals like those used in chemotherapy often develop significant health setbacks that can last a lifetime, even if the therapy was effective in eradicating cancerous cells. Proton beam therapy provides a safer alternative for young children still developing physically during the treatment process.

Some of the biggest disadvantages of proton beam treatments are cost and availability. The machines used in therapy sessions are still fairly rare, highly complex, and extremely expensive to manufacture, maintain, and operate.

It is most likely that your regular oncology office will not house proton beam equipment, meaning you will need to travel to another location for treatment.

According to the National Association for Proton Therapy (NAPT) location guide, there are only five proton therapy treatment centers in the Western United States: the Huntsman Cancer Institute at the University of Utah, The Mayo Clinic Proton Beam Therapy Center – Arizona, the California Protons Cancer Therapy Center in San Diego, James M. Slater, MD Proton Treatment & Research Center at Loma Linda University Cancer Center, and the Fred Hutchinson Cancer Center in Seattle.

For most residents of Nevada, the nearest proton therapy treatment center is located at the University of Utah Huntsman Cancer Institute.

What Does Proton Therapy Treat?

Proton therapy is used almost exclusively to treat cancer, although non-cancerous tumors have also been treated using a proton beam. Research into its uses is still ongoing. Johns Hopkins Medicine lists the types of cancers that can be treated using proton therapy as:

  • Brain tumors
  • Base of the skull tumors
  • Eye cancer
  • Spinal cord tumors
  • Brain and neck cancer
  • Breast cancer
  • Lung cancer
  • Liver cancer
  • Pancreatic cancer
  • Prostate cancer
  • Rectal cancer
  • Sarcoma
  • Recurring tumors

Why Do Insurance Companies Deny Proton Therapy Claims?

There are a number of reasons insurance companies may give when denying a proton beam cancer therapy claim. It is not uncommon for an insurer to deny coverage by citing a reason such as:

  • The therapy is experimental
  • The procedure isn’t medically necessary
  • A cheaper treatment option could achieve the same or similar results

In almost all cases, a denial comes down to money.

Proton therapy has long been accepted as a safe treatment for certain cancers. In 1988, the therapy was first approved by the U.S. Food and Drug Administration (FDA) as a viable treatment option for a number of different types of tumors. However, due to its high price tag and limited availability, it is still subject to scrutiny by many insurance companies unwilling to see past the cost.

We Don’t Tolerate a Profits-Over-Policyholders Business Model

Your doctor knows your health far better than your insurance adjuster.

If proton therapy is a recommended course of treatment for your condition, an insurance company that tries to deny coverage on the basis of price could be acting in bad faith.

In situations like these, the involvement of a proton therapy insurance denial lawyer may be the best way to make sure you can afford the cancer therapy that’s best for you.

We can support you in making an appeal to your health insurer after a bad faith denial by:

  • Gathering evidence of your interactions with your oncologists and other health care providers
  • Securing proof that proton beam therapy is a recommended treatment option
  • Supplying documentation proving the history of your disease and projected therapy outcome
  • Partnering with top-tier medical experts and specialists who can verify your claim
  • Analyzing the insurance company’s actions to identify any violations of the terms of your policy or other acts of bad faith

Who Should I Talk to if My Insurance Company Denied My Proton Beam Therapy Claim?

Your health should never be dictated by what your insurance company is willing to pay.

The proton therapy insurance denial attorneys at the Law Office of Matthew L. Sharp are here to help you defend your rights. If your health insurer denied your proton beam therapy claim, we are the law office best positioned to fight on your behalf.

Cases involving denied cancer treatment claims require the expertise of a legal advocate who focuses on this complicated area of the law. While we cannot guarantee a specific outcome in your case, we can promise that we will use the full extent of our knowledge, resources, professional relationships, and experience to give you the best chance at the most successful case outcome.