In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Fargo (Headquarters) Yes, most Blue Cross Blue Shield insurance plans cover online therapy, and many Blue Cross Blue Shield chapters have partnerships with online networks, such as Live Health Online. The largest insurance network is Blue Cross and Blue Shield. Commercial insurance companies will pay … BCBS of Missouri paid mine but they weren't in a hurry to confirm it. Proton Beam Therapy (PBT) is a form of external beam radiation therapy (EBRT) also known as charged particle therapy. Anderson in Houston, TX. 37 Replies, Can anyone provide me with supporting data, studies, articles by authorities regarding proton beam therapy's ability to : 1. Has anyone had 5-fraction SBRT (proton-based) treatment at Mayo Clinic. 12 Replies, Pencil beam Proton therapy vs. passive scatter Proton therapy. Even with this there was a mix up in getting the pre-authorization and we got it covered with some extra work. Success ? Dear JML40 According to our ... for my husband's marker implantation (10/31), followed 2 days later by a CT scan and MRI. Many companies, including United HealthCare Insurance Company and Blue Shield, also deny medical claims for proton beam therapy for the treatment of prostate cancer on the basis it is investigational. We've read the articles...have chatted with the great people on this list...spoken with two urologists and two radiation oncologists and have decided to proceed with the proton therapy. But over time, our state’s largest insurer lost its way. The Mayo Clinic is currently constructing a $200 million proton beam therapy center in Rochester, MN. If you want to reach me, you can send an email to cpart@spamarrest.com and we can swap phone numbers. My husband was diagnosed with Gleason 7 (3+4) prostate cancer in December 2019. -- Blue Cross: Provide coverage for proton therapy to save our Mom This petition had 966 supporters Marie Garlock started this petition to Blue Cross Blue Shield and 2 others Minimize radiation ... The scheduled completion date is 2015 and I can't wait that long. PBT provides the opportunity of achieving dose escalation and decreasing toxicity by delivering physical dose to a narrowly defined region, while avoiding normal tissue. 21 Replies, Proton therapy insurance coverage questions, Medical Insurance Coverage for Proton Therapy for Prostate Cancer, Proton therapy for prostate cancer—Pencil beam or passive scatter-. Of course, this is a disease that has to be managed over time but even so....we have never questioned our choice. I would very much like to do a form appeal letter for PBT. 21 Replies, I am considering this option along with SBRT Cyberknife or a longer course of Proton Beam treatment (at least 20 treatments) My concern is that ... I am going to talk with BCBS of Minnesota next Thursday. Not all plans are available in all areas, so it's important to call your insurance company to confirm if your plan is available at Texas Center for Proton Therapy. I would be helpful if I can go into the meeting knowing BCBS of MN covered someone for proton beam therapy in the past. While Anthem does indicate that it covers proton beam therapy for certain conditions, such as brain tumors or tumors on the spinal cord, it specifically excludes coverage for prostate cancer. Astro Guidelines are used in the determination of proton radiation therapy for other indications. They strongly pushed surgery. “Blue Cross Blue Shield covered proton therapy for prostate cancer until April of last year, and now, inexplicably, it will not,” Yonemoto said. Not certain of BCBS. Today, I made an appt. On the website, it indicates that BC/BS does contract with Pro-Cure but I wanted to make sure. HMOs are notorious for not covering it. Does anyone know if Blue Cross Blue Shield (BCBS) of Minnesota covers proton beam therapy for prostate cancer? It has been a positive experience in virtually every respect (taking into account, of course, that my husband has cancer) and we've met amazing people from the ProCure docs....to the other patients and their wives.....to the radiation therapists. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records. Proton Beam Therapy (PBT) is a form of external beam radiation therapy (EBRT) also known as charged particle therapy. member education. Palliative treatment in a clinical situation where normal tissue tolerance would not exceeded in previously irradiated areas. As such, insurance companies must also cover it. They are saying that the proton will not produce any better results than the traditional photon radiation. Examples of such an advantage might be: The target volume is in close proximity to one or more critical structures and a steep dose gradient outside the target must be achieved to avoid exceeding the tolerance dose to the critical structure(s). I have narrowed my choice between Indiana ... PBT in combination with photon therapy for any tumor is considered experimental/investigational and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. CIGNA Proton Beam Therapy for Prostate Cancer Unknown … Is there any advantage to the newer pencil beam technology in the treatment of ... My husband is 72 and on Medicare and has Blue Cross/Blue Shield of Illinois for his supplemental. What are proton pump inhibitors (PPIs)? I also called the PBT Center's financial office to make certain that we'd be covered. Rather than wait I went with local IMRT and finished my 45 treatment 10-9. Does anyone know if Blue Cross Blue Shield (BCBS) of Minnesota covers proton beam therapy for prostate cancer? Has anyone out there who has had PBT speak to this? A comprehensive list of therapies and medications used in the member’s cancer treatment, including chemotherapy history and/ or history of previous radiation therapy to same or an immediately adjacent area. Browse our extensive directory of the best BlueCross and BlueShield Therapists, BlueCross and BlueShield Psychologists and BlueCross and BlueShield Counselors near you. I am going to talk with BCBS of Minnesota next Thursday. 20 Replies, One of the things that bothers me in the world of PCa, between urologists and interventional radiologists, is that there is virtually no comparative ... It came back approved but it took awhile. and there was just the normal red tape of passing the paperwork through many hands before someone finally said, "yes, this procedure is covered." Blue Shield of California has notified 300 radiation oncology and urology practices in the state that, as of the end of October, it will no longer cover proton-beam therapy for prostate cancer. Proton Pump Inhibitors (PPIs) Using a research-based approach, Anthem Blue Cross and Blue Shield chooses safe, effective PPI medications used to treat heartburn and other acid-related conditions for the drug list/formulary. Texas Center for Proton Therapy participates in most health insurance plans, Medicare, Medicaid, and selected Health Insurance Marketplace plans. 4510 13th Ave. S. Kaiser Northern California refused to even consider PBT. Together with an Nurse and a Physician, I am developing a set of appeal letters and a short instruction book on how to appeal insurance denials. Alas, prostate cancer isn't in that group. My understanding of Medicare and PBT is that there is no insurance issue. I also understand folks on Medicare had no major problems for coverage. We have only two days left in our 44 days of treatment and I can tell you that we are SO glad we chose this route. 22 Replies, Just finished my 44 treatments. Starting a new discussion thread (again) because in looking over the PBT discussions, I'm not seeing this particular issue addressed. I believe our new Obamacare system is going to put more and more pressure on higher cost treatements, especially when lower cost ones exist. Documentation stating one or more medical necessity requirements outlined in this policy. ... Kaiser Foundation Group, Aetna, and Humana. No major problems. The same or an immediately adjacent area has been previously irradiated, and the dose distribution within the paient must be sculpted to avoid exceeding the cumulative tolerance dose or nearby normal tissue. The list below reflects some of the plans we accept. Finished Jan. 9. Get timely provider information including policy, benefits, coding or billing updates, education, and more—delivered directly to your email. Began treatment Oct. 31. Wish I could be of help but all I can tell you is that BCBS does cover it in Illinois. Indications considered for potential coverage include: Instances where sparing the surrounding normal tissue cannot be adequately achieved with photon-based radiotherapy and is of added clinical benefit to the individual. Inclusion of a code in this section does not guarantee that it will be reimbursed. This discussion is closed to comments. The Mayo Clinic is currently constructing a $200 million proton beam therapy center in Rochester, MN. Proton radiation treatment, or proton beam therapy, is the most precise and advanced form of radiation therapy available ... Ultimately, authorization was given. Rather, it's in Group Two, for which proton therapy is covered by Medicare as long as certain special conditions are met. Each of these payers will make an individual determination on what types of cancer they will pay to have treated with proton therapy. Also, BCBSMS has at times approved this type of treatment. Full coverage: While proton beam cancer therapy treatment is covered by Medicare, private insurance coverage varies. The potential benefit is to improve local control, improve survival, and decrease toxicity. They will also negotiate rates with individual centers for these treatments. Blue Cross & Blue Shield of Mississippi does not control such third party websites and is not responsible for the content, advice, products or services offered therein. I have chosen proton beam therapy at M.D. You should get coverage on appeal. I was in a hurry to get the treatments started, so had to work a bit with the financial person at PRoCure as well as on my end to get 'everybody to the table' in time for me to start on the date that worked for me. An Independent Licensee of the Blue Cross and Blue Shield Association Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease (GERD) This policy may apply to the following codes. Anderson in Houston, Texas and have been accepted for proton beam therapy treatment there. An Independent Licensee of the Blue Cross and Blue Shield Association Charged Particle Radiotherapy Policy BCBSNC will provide coverage for Charged Particle Radiotherapy (Proton or Helium Ion) when it is determined to be medically necessary because the medical criteria and guidelines shown below are met. You can go through those directories, or ask member services whether online sessions with your therapist of choice are covered. That is another reason I did not wait the year. Hope your experience is as positive as ours. If you have the option, change to a better insurer if you get resistance. Fargo, North Dakota 58121, Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Of course, if we continue to move toward socialized medicine where you don't get a choice in your treatment options....who knows. When Blue Cross Blue Shield planted its flag in Texas, it was committed to providing quality health care. This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not New Jersey’s Health Insurance Marketplace. Spinal cord compression, superior vena cava syndrome, malignant airway obstruction, poorly controlled malignant bleeding and other scenarios of clinical urgency. I am part of the clinical trial comparing proton beam therapy to standard photon radiation. They now use a group called evita.com to process all there pre-approvals. 17 Replies, I have early stage prostate cancer and have been on AS for the last 7 years, my Gleason score from all three biopsy's has been 3+3 =6/10 and ... I can tell you that at ProCure Warrenville, there is a steady stream of foreign patients (many children) paying out the wazoo to come here for Proton Therapy. Therefore, you are about to leave the Blue Cross & Blue Shield of Mississippi website and enter another website not operated by Blue Cross & Blue Shield of Mississippi. PBT provides the opportunity of achieving dose escalation and decreasing toxicity by delivering physical dose to a narrowly defined region, while avoiding normal tissue. Some insurers, including Cigna, Independence Blue Cross, and Blue Cross Blue Shield of Florida, cover proton therapy for selected cancers being studied, sometimes with study participation. Best of luck! My name is Dana Von Voss and was diagnosed with stage 4 Orapharyngeal cancer and am wanting to use proton therapy irradiation to treat it, but Blue Cross Blue Shield is refusing to pay for it. I would make the request both by phone but also by written letter as well. Where PBT does not offer an advantage over photon-based therapies that otherwise deliver good clinical outcomes and low toxicity. With the additional centers being built in the US, I think the worry of whether or not insurance will pay for it will diminish. Inability to accommodate for organ motion. Marcus Thygeson -- a physician and chief health officer at Blue Shield -- said, "The real issue here is the growth of these expensive new technologies that drive up the cost of health care when there is no evidence of improved outcomes," adding, "It's important we set limits on their use so we can achieve a high-quality health care system but also an affordable one." After lots of research, we are thinking about proton therapy ... Anderson in Houston, Texas and have been accepted for proton beam therapy treatment there. 21 Replies, after several months of research, I have decided on proton beam for treatment of my prostate cancer. Anthem Blue Cross goes into great detail on its website about coverage for prostate cancer. I started ... 107 Replies, Hello Members, I'm 65 and a retired sales rep. I had minimal side effects during my treatment, but ended up getting ill just after the last treatment and had my gall blatter out just a week later. But … We applied to Anthem Blue Cross, was approved in ~two weeks, started coverage Oct. 1, had my first consultation at Loma Linda Oct. 8, and had full insurance approval on Oct. 23. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. I was told by Loma Linda that all recent trys to get GEHA to cover proton had failed. I live in Belmont Shore, California, and I've enjoyed reading all of your inspirational and informative ... Blue Cross and Blue Shield, refused to pay, saying the treatment was “not medically necessary,” and “experimental and without justification.” Jack and Dianne were appalled to learn that Anthem justified its denial of payment based on guidelines from the American Society for Radiation Oncology (ASTRO) that were four years old and had been updated to include her diagnosis. Coverage is subject to the specific terms of the member’s benefit plan. I have visited M.D. Mail to: Blue Cross Blue Shield of Massachusetts PO Box 986065 Boston, MA 02298 Services rendered outside of Massachusetts: Submit to your Local Plan Complete the Clinical Exception and Notification Form for BCBSMA Medical Policy 437, Charged-Particle (Proton or Helium Ion) Radiation Therapy Providers must complete the Clinical Exception and Notification Form below when requesting … PPi medications are used to treat heartburn, ulcers, acid reflux and gastroesophageal reflux disease (Gerd). BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. For conditions in Group One, Medicare covers proton therapy outright. One first step, I would recommend requesting Blue Cross/Blue Shield of Illinois for a written "Pre-Service Determination/Authorization". The side effects have been virtually "nil". The financial person I spoke with did not foresee any problems but said that there was no "pre-procedure approvals". Medicare and Medicaid already cover proton therapy in some states. Almost every insurance company cover Proton Therapy. The potential benefit is to improve local control, improve survival, and decrease toxicity. In fact, in Robert Marckini's great book "You Can Beat Prostate Cancer" list all the insurance companies that have covered Proton therapy and Regence Blue Cross/Blue Shield of Oregon is one of them. The … CIGNA HealthCare does not cover proton beam therapy for choroidal hemangiomas or macular degeneration, because it is considered experimental, investigational or unproven. Blue Shield said that it only will pay for proton beam therapy in cases where clinical evidence supports its use, such as for certain tumors in children. 41 Replies, Hi, I have a thread going about my situation (https://www.inspire.com/groups/us-too-p rostate-cancer/discussion/deciding-the-r ight-treatment ... The Procure Center requested pre-approval from Tricare for me. 32 Replies, Anyone have proton beam therapy? Are you sure you want to delete this reply? Essentially, anthem Blue Cross stands behind a denial of coverage for proton beam therapy saying that studies do not support its superiority over other methods to treat prostate … To start a new discussion in this community, please click here. What Does Proton Therapy Cost? I have GEHA goverment insurance with Medicare part A only. I am a 66 year old healthy guy ( I thought ) I was diagnosed with PC last week ... Benefit is to improve local control, improve survival, and more—delivered directly to your email next. 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