Proton beam therapy is a highly sought-after alternative treatment option to chemotherapy, but insurance companies sometimes refuse to cover the cost.

While denial of coverage for proton beam therapy is common throughout the United States, California patients are starting to fight back by taking legal action against insurance companies for wrongfully denying them coverage.

Proton beam therapy has been around since the 1950s, and was officially approved as a cancer treatment by the FDA in 1988. The state of California even has designated treatment centers for proton beam therapy, but cancer patients may find it difficult to receive insurance coverage for this option.

Proton beam therapy is particularly effective against treating cancers that chemotherapy and radiation normally have trouble with, such as localized tumors that have yet to metastasize. The popularity of proton beam therapy exploded in the 2000s, due to many medical technological advancements.

In result of this new found fame, 20 proton therapy centers have opened throughout the United States in the last 15 years, and over a dozen more are set to open in the next five years. However, popularity of this treatment has led many California patients to discover their insurance companies will not cover the procedure, and they will likely face denial of coverage for proton beam therapy.

Overview of Proton Beam Therapy

Proton beam therapy is offered in many hospitals in California, like the Proton Treatment and Research Center at Loma Linda Medical Center, and is considered to be highly effective against specific cancers.

Proton beam therapy is the most advanced version of radiation cancer treatment in the United States, as doctors are able to shape the particle beam to the exact dimensions of the tumor. Compared to traditional radiation therapy that uses X-rays, proton beam therapy can only go as far as the patients’ tumor goes and can only stay within the treatment parameters.

This allows doctors to terminate the tumor without affecting any other tissue or organs. This particular type of radiation treatment is especially effective in sensitive areas including the brain, head, breasts, neck, lungs, and pancreas.

With how invasive chemotherapy treatment is and how dangerous radiation can be to healthy tissue, many patients in California would prefer proton beam therapy if the option is available. In addition, patients have reported few side effects from this therapy and even when reported, they are far less severe than the ones typically associated with chemotherapy and traditional radiation therapy.

Even though this treatment option has gained popularity over the years, many insured patients still face denial of coverage for proton beam therapy.

Patients in that situation may be in a position to bring a claim of bad faith against the insurance company. This means that the insurance company failed to act on behalf of the policyholder’s best interest, which many would argue in cases of denial of of coverage for proton beam therapy.

California patients who allegedly experienced a wrongful claim denial for proton beam therapy may be able to file legal action against insurance companies. Potential claimants should contact a knowledgeable health insurance lawyer to evaluate their case for a claim denial for proton beam therapy.