Prospective patients and other doctors often ask us questions about the cost of proton therapy. It is expensive? does the insurance cover it? How much is it if the insurance doesn’t pay? These are all important questions worth addressing.
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Does insurance cover proton therapy?
All major insurance companies cover proton therapy treatment. This list includes Blue Cross, UnitedHealthcare, Aetna, Cigna, Humana, Tricare, and many more. In addition, Medicare and Medicare replacement plans offer extensive coverage for proton therapy.
Coverage offered by commercial payers may vary by payer and patient’s specific insurance plan. at the oklahoma proton center, nearly 80% of patients with commercial insurance get approval from their insurance plan to receive treatment at the center. We work with each patient prior to treatment to determine what the benefits of her will be for her diagnosis and treatment regimen.
Medicare Approves Proton Therapy Treatment at Oklahoma Proton Center; therefore, medicare patients can rest assured that their treatment will be paid for. By law, Medicare replacement plans must offer the same coverage as Medicare, so patients with these plans will also be covered, although a referral may be required.
How much does proton therapy cost?
As is often the case in health care, this question is up to the payer. Medicare pays about $1,000 per treatment; therefore, if a patient has a 20% copay, she will owe about $200 per treatment.
Various commercial payers pay a different amount that can range from a little more than Medicare to around $2,000 per treatment. the amount owed by these patients will depend on your plan.
Most patients have a plan that limits their out-of-pocket costs to a maximum dollar amount, regardless of their deductible or coinsurance percentage. Financial counselors at the Oklahoma Proton Center can help patients interpret the nuances of their plan so they know exactly how much they will owe before treatment begins.
the oklahoma proton center is a not-for-profit health care provider with a generous charity care policy. The center can provide discounts or grants based on need, as well as structured payment plans that can help patients pay for treatment. we don’t want the cost of treatment to be a burden that prevents patients from receiving the care they need.
Is proton therapy more expensive than other treatment options?
This depends on several factors, including where the other treatment is provided and which treatment(s) are included. For example, the Oklahoma Proton Center is a stand-alone facility, so the cost of proton therapy here may be less than traditional radiation treatment at a hospital that charges much higher fees.
Chemotherapy, immunotherapy, and other targeted therapies can often cost hundreds of thousands of dollars. The average cost of a proton therapy course at the Oklahoma Proton Center is approximately $45,000. so this is much less expensive than some of these other options.
Furthermore, the “cost” burden of treatment is not only the cost of the treatment itself, but also the cost of treating the side effects of the treatment. Although proton therapy may be more expensive up front than other types of radiation treatment, the cost is often lower in the long run due to fewer treatment-related side effects.
in fact, an md anderson study conducted in conjunction with the state of texas employee health benefit plan showed that over a 6-month period, the total cost of caring for a proton therapy patient was less than the cost of a comparable patient receiving imrt (photon-based radiation treatment). this was due to the reduction in treatment-related complications for proton therapy patients.
What else should I know?
Ultimately, what is most important is that a patient receives the best treatment possible no matter where or what they are from, or what the cost is. That’s why it’s so important for patients to be their own advocates and do their research. each patient should explore all possible treatment options before making a decision.
If you have any questions about proton therapy, cost, your insurance plan, or how proton therapy may work for your cancer, please call us at (405) 773-6700.