Some California health insurance providers treat proton therapy as if it were a new and untested treatment. The truth is that proton therapy was invented in the 1940s and has been used successfully to treat cancer since the 1950s.

Proton therapy is an alternative to the X-ray therapy more commonly used to treat cancer. The equipment used in proton therapy accelerates protons to around two-thirds the speed of light and aims a beam of them at the patient’s cancerous tissue.

From the patient’s point of view, the main difference between proton therapy and traditional radiation treatment is that proton therapy is able to precisely target the cancerous tissue without damaging the healthy tissue nearby.

Care providers can focus the proton beam to conform to the size and shape of the targeted tumor. Then the protons are accelerated with just enough energy so that once they enter the body, they will go no farther than the target tissue.

X-ray treatment doesn’t offer that kind of precision. It results in healthy parts of the body being exposed to radiation, generating immediate side effects and the potential for long-term complications.

The ability to precisely target the treatment has made proton therapy particularly applicable to treating cancer in areas of the body where that much precision is beneficial. Patients with cancer in the head, neck, lungs or prostate may get a particular benefit from having access to proton therapy.

Getting Coverage from California Health Insurance

The benefits of proton therapy come at a significant cost, because the equipment and expertise needed to provide proton therapy can be very pricey.

A traditional proton therapy machine can cost between $150 and $250 million. Even the monthly electric bill for a proton therapy facility can run into the hundreds of thousands of dollars.

For that reason, some California health insurance companies don’t want to pay for proton therapy. Patients whose insurers have rejected coverage for proton therapy have been told it’s an “experimental” treatment that does not qualify for coverage.

Because of that extraordinary cost of proton therapy, there are only a few dozen facilities that can provide it. Only a handful of such facilities are running in California.

One such center in San Diego recently filed for bankruptcy reorganization after being open for only three years. In a recent article published by The San Diego Union-Tribune, representatives of the Scripps Proton Therapy Center say they have received significantly fewer referrals than they expected when they opened the facility.

The representatives say a withdrawal of insurance coverage for prostate cancer is partly to blame. Scientific evidence supporting proton therapy for prostate cancer is not as strong as it is for other applications.

For that reason, California health insurance providers pulled coverage for proton therapy for prostate cancer in 2014 – the same year the Scripps Center opened its doors. As a result, say center executives, the center got far fewer referrals for prostate cancer treatment than they expected.

The Scripps Center will continue to operate during the restructuring, according to representatives. Short-term loans will allow the facility to continue running while the bankruptcy proceeds. Patients receiving treatment should not notice a difference in treatment, the representatives say.

Denials of coverage for proton therapy don’t have to be taken at face value. California health insurance companies sometimes make improper denials in bad faith, putting the patient in a position to make a legal claim against the company. Consulting a knowledgeable insurance attorney can give patients a good idea of all their legal rights and options.