If you have been diagnosed with cancer, it is critical that you receive the care you need based on your doctors’ recommendations. It should be you and your doctors that decide your treatment plan, not your insurance company. If your doctors have prescribed proton therapy, but your insurance company will not pay for it, we can help. Whether your claim for proton therapy has just been denied or you are preparing to appeal the insurance denial, our attorneys have the experience to fight for your health benefits and the treatment you need.
What Is Proton Therapy?
Proton therapy uses protons to match a cancerous tumor’s shape to deliver a more precise, but increased dose of radiation, while decreasing exposure to the surrounding healthy tissue. As a result, proton therapy has been deemed just as effective, but safer than traditional radiation in many instances.
What Types of Cancer Is Proton Therapy Used to Treat?
Proton therapy has been deemed successful in treating various types of cancer, including:
- Base-of-skull tumors
- Brain tumors
- Breast cancer
- Eye cancer (melanoma)
- Head and neck tumors
- Lung cancer
- Prostate cancer
- Spinal tumors
Nonetheless, whether your proton therapy is covered for your type of cancer, depends on the specific terms of your health plan.
Does Insurance Cover Proton Therapy?
Proton therapy was first discovered in the early 1900s, and approved by the U.S. Food and Drug Administration (“FDA”) for cancer treatment in 1988. Nevertheless, proton therapy tends to be more expensive than traditional radiation and is still not covered by many insurance companies. There are various reasons insurance companies will deny coverage for proton therapy, including claiming it is experimental or not medically necessary for your particular cancer diagnosis. Proton therapy may still provide the life-saving treatment you need. That is why it is crucial you consult with legal counsel with experience in dealing with health benefits denials such as the attorneys at DeBofsky Sherman Casciari Reynolds P.C. We can advise you on the specific terms and limitations in your health plan, and how to fight for coverage of the cancer treatment you need.
Health and ERISA Lawyers With a Record of Getting Proton Therapy Insurance Denials Overturned
The lawyers at DeBofsky Sherman Casciari Reynolds P.C. have a proven track record of getting payments for their clients denied medical care, including proton therapy.
Know Your Rights
Whether your proton therapy is covered for your type of cancer, depends on your specific health plan.
Our team has the knowledge and experience to evaluate your plan and guide you to get the benefits to which you are entitled and the care you need.
Does This Apply to You?
Contact DeBofsky Sherman Casciari Reynolds P.C. for an attorney consultation. We will work with you to figure out your problem, and how we can help.
What Can I Do if My Insurance Company Denies Coverage for Proton Therapy?
If your insurance company denies coverage for proton therapy, you have options. In most cases, you will have the opportunity to submit an appeal to the insurance company to try to get the denial overturned. If your appeal is denied, you can then file a lawsuit challenging the decision in court.
The seasoned health and ERISA attorneys at DeBofsky Sherman Casciari Reynolds P.C. are here to consult and assist you through every step of the process – from filing your claim to taking your case to court.
We Fight for Your Benefits So You Can Focus On Your Health
If you or a loved one have been diagnosed with cancer and need proton therapy, but your insurance company refuses to pay for it, the legal team at DeBofsky Sherman Casciari Reynolds P.C. are here to help. Contact our firm today to find out how we can get your insurance company to pay for the treatment you need.
“Went above and beyond to help me with my case.”
Tricia D| Client
Learn More About Proton Therapy and Health Benefits
A concurrence to a Sept. 22 opinion issued by the U.S. Court of Appeals for the Fifth Circuit in a case involving a health insurance raises serious concerns about the manner in which courts review benefit claim denials under the Employee Retirement Income Security Act […]
Health insurance is a critically important benefit since illness and injury are unpredictable, and the high cost of medical care makes it unaffordable to most people absent insurance. Healthcare coverage is confounding, especially if one has health insurance through their employer and are eligible for Medicare due to the so-called Medicare as secondary payer rules […]
If your insurance coverage is provided in accordance with the Affordable Care Act (Obamacare) or you have Medicare, your coverage is comprehensive and will cover treatment for cancer. However, there are many situations in which coverage for cancer treatment may be denied, as the following discussion explains […]