When individuals are faced with cancer diagnosis, many will begin to spend countless hours researching treatment methods, side effects and alternatives.

One fairly recent treatment available to assist with addressing a variety of cancers is proton beam therapy. Proton beam therapy is a kind of radiation treatment that uses a beam of protons focused at a very precise location in the tumor. With proton therapy, the tissue surrounding the tumor is less likely to be damaged because of how specific and targeted the proton beam can be as compared with traditional radiation therapy.

However, insurance coverage for proton therapy is limited. For many patients, this denial of coverage for proton therapy renders it out of reach, only allowing patients to access more traditional forms of cancer treatment.

There are only a handful of medical centers across the United States that actually perform proton beam therapy. The first treatment center for proton beam therapy at a hospital setting was located at Loma Linda University Medical Center in California. This location and others across the U.S. allowed more patients to be treated with this less invasive therapy offering fewer side effects.

One of the main cancers treated by proton beam therapy has been prostate cancer. Patients undergoing prostate cancer treatment with proton beam therapy typically had less damage to the surrounding tissue located near the prostate area.

However, over time, insurers found that the cost of proton beam therapy was more than that of traditional radiation therapy. While focusing solely on the treatment results in terms of ridding the body of cancer, proton beam therapy and radiation therapy performed similarly.

Because proton beam therapy was more expensive, insurance companies began to deny coverage for proton therapy even though it offered the benefits of causing less damage to patients.

There are some cases where insurance companies will approve coverage for proton therapy. If the tumor is located in a specific area, such as in the brain or on the spinal cord, companies are more likely to cover proton therapy. However, in cases like prostate cancer and other types of cancer, insurance companies often refuse to cover proton therapy.

Taking Legal Action after a Denial of Coverage for Proton Therapy

Patients, physicians and medical centers question the reasons for denial of coverage of proton therapy, claiming that insurance companies should cover less invasive form of cancer treatment for those who wish to access it. Insurance companies been accused of putting profits before people in trying to save money rather than trying to save the health of individuals.

Insurance companies have been accused of bad faith insurance practices by refusing routine coverage of proton therapy. Companies may deem this type of therapy experimental or medically unnecessary, or they may simply state that other, equally effective opportunities for treatment exist that are covered under the patient’s plan.

If your insurance company has denied coverage for proton beam therapy in California, you may be eligible to take legal action against the insurance company. An attorney experienced in dealing with denial of coverage for proton beam therapy can review your case for free and can inform you of your rights and opportunities for seeking legal recourse.