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Proton Therapy Cases in Oregon
Proton beam therapy – more commonly called just proton therapy – is one of the most effective radiation treatments for cancer with minimal risks of dangerous side effects. However, it is also considerably expensive, which is why insurance companies hate approving claims for it.
Did your health insurance provider deny your proton therapy treatment claim and you suspect they did it only to protect their profit margins? Do not stand for such mistreatment that threatens your health and your financial stability. Explore your legal options to challenge the claim denial with the help of Kantor & Kantor, LLP in Wilsonville. Our attorneys have focused almost-exclusively on insurance claim denials for decades, making us one of the most experienced law firms in the area for these case types.
Benefits of Proton Therapy
Chemotherapy is effective at slowing cancerous growths in many patients, but it is also extremely demanding on a patient’s health. X-ray radiation therapy can work for some patients, but it also carries some risks of radiation exposure. Proton therapy combines high effectiveness and minimal side effects into one treatment method.
Many doctors and patients alike consider proton therapy to be the optimal cancer treatment available right now. The only downside is that proton therapy sessions are expensive. Most patients require at least three schedules of treatments, each costing about $15,000. Insurance companies will try to deny a proton therapy claim simply because it is expensive.
We want to hear from you. Call 818-886-2525 to speak with our Portland proton therapy insurance claim denial lawyers today.
Does Insurance Cover Proton Therapy?
There is no guarantee that proton therapy sessions will be covered by your insurance policy. It is, after all, a specific type of cancer treatment that not all medical institutions offer or accept as a way to safely destroy cancer cells. Before you jump to the conclusion that your claim was wrongfully denied, it is worth checking your health insurance policy to see if proton therapy is even covered. Interpreting the details of your healthcare insurance policy can be intentionally difficult, though, so remember that you can come to our firm for all the help you need.
Reasons Insurers Deny Proton Therapy Claims
Your insurer might deny your proton therapy claim due to:
- Material misrepresentation: When an insurance application or renewal is completed with inaccurate information, it is called material misrepresentation in the world of insurance. A claim can be denied if an instance of material misrepresentation is significant enough to jeopardize the validity of the entire application. Some dishonest insurance companies will deny a claim and cite material misrepresentation without explaining what they mean by it.
- Out-of-policy treatment: Some health insurance policies do not cover advanced or new medical treatments, such as proton beam therapy. If your insurance provider excludes proton therapy from your policy, then it might be difficult to challenge their denial. However, a careful review of your policy could reveal that proton therapy should be covered, at least partially. Do not assume you are out of options. Speak with a lawyer instead and see what can be done.
- Policy caps: Given that proton therapy is expensive, it is possible that the necessary treatment sessions could surpass your annual policy coverage caps, especially if you have already required recent medical treatment for other health issues. If this is the case, then you might want to speak with your doctor about alternative treatment options now and plan for proton therapy after your policy renews and the caps reset.
What to Do After a Proton Therapy Claim Denial
If your proton therapy claim is denied, it can be disorienting and troubling. What are you supposed to do if you can’t even get the cancer treatments your doctor recommended? Firstly, do not panic. Secondly, call (503) 744-5994.
Our Portland proton therapy attorneys are here to help you decide what to do after a proton therapy claim denial. Typically, we will want to start with reviewing your policy and the denial letter. Based on what we uncover, we can take the next steps to correct the situation, like challenging the denial or even planning for litigation.
Proton Therapy FAQs
Proton therapy uses a synchrotron or cyclotron machine to send proton particle radiation – not x-ray radiation – to target cancer cells in the patient. The proton particles can pass through the skin and healthy cells to the target site. Proton therapy is praised by many oncologists due to its lower risk of causing harm to unaffected organs and tissues.
Due to the specific targeting method of proton beam therapy, it has been used to treat various forms of cancer with precision. Many patients who undergo proton therapy have head, neck, spine, breast, prostate, and brain cancers, but this is not an all-inclusive list. You should speak with your doctor to see if your cancer can be treated by proton therapy because there is a good chance it can be.
Attorney Glenn R. Kantor
Glenn Kantor is a founding partner of Kantor & Kantor LLP. As a young attorney, Glenn saw the injustice of wrongful insurance denials and created a law firm to represent individuals seeking to obtain their rightful benefits. Glenn is committed to ensure that clients receive the benefits they are entitled to under their insurance policies or group health plans. [Attorney Bio]
