Loren Swearingen

By proton-admin | August 20, 2018

“No matter how much data or references I provided, it became evident that my insurer was essentially stonewalling. Anthem had made up their mind from the beginning, and no amount of evidence or appeals would change that.”

 


When I learned that I had prostate cancer, I immediately investigated my options. I conducted a thorough search online and found an informative article entitled, The 10 Myths About Proton Therapy, which led me to contact the MD Anderson Proton Therapy Center.

When I first contacted the MD Anderson Proton Therapy Center, they informed me that there was only about a fifty percent chance that my insurer would cover the cost of the proton therapy. However, after conversations with my doctor, I knew proton therapy was the best medical option to preserve my quality of life. I made the decision to move forward with the proton therapy treatment, even if the insurer refused to reimburse me.

After filling out the insurance application with the help of MD Anderson, Anthem denied my coverage. Their initial response was so slow that it violated my company’s health insurance contract which requires a timely response. Cancer care should not be a waiting game.  Even though MD Anderson placed me on hormone ablation therapy, which shrinks the cancer cells and slows their growth, I still worried that the slow growth could compound my medical problems while Anthem deliberately delayed my treatment. While MD Anderson helped me throughout the application and appeals process, Anthem continued to reject my claim deeming proton therapy was “experimental.” Attempts to appeal Anthem’s decision through an independent review board were also rejected on the basis that proton therapy was “experimental.”

No matter how much data or references I provided, it became evident that my insurer was essentially stonewalling. Despite repeated requests, Anthem and my employer would not respond to MD Anderson’s request to discuss the matter or review their comparative treatment costs. Anthem had made up their mind from the beginning, and no amount of evidence or appeals would change that.

My appeals process dragged out for six months and impacted my treatment schedule and treatment options. All the while, I was concerned that my cancer might slowly spread outside my prostate gland, even though my cancer’s growth was slowed down by hormone ablation treatment. Finally, I decided that I couldn’t wait any longer and began treatment.

Proton therapy saved my life, and I’m glad that I pursued this form of treatment. However, I had to pay $90,000 out of pocket for it. While my treatment was a financial setback, it was well worth it.

For other patients struggling for access to proton therapy, remember not to give up. No matter the amount of pushback from insurers, it’s crucial that patients fight for coverage until all their options are exhausted. No cancer patient should have to deal with insurers’ games. Fighting cancer is already hard enough.