Proton Therapy- What about the Cost?

We often get asked questions by prospective patients and other physicians about the cost of proton therapy. Is it expensive? Does insurance cover it? How much is it if insurance doesn’t pay? All of these are important questions worth addressing.

Does Insurance Cover Proton Therapy?

All of the major insurance companies cover proton therapy treatment. This list includes Blue Cross, UnitedHealthcare, Aetna, Cigna, Humana, TriCare, and many more. Additionally, Medicare and Medicare Replacement plans offer broad coverage for proton therapy.

The coverage offered by commercial payers can vary depending upon the payer and the patient’s specific insurance plan. At Oklahoma Proton Center, nearly 80% of patients with commercial insurance that request authorization get approved by their insurance plan for treatment at the facility. We work with each patient prior to treatment to determine what their benefits will be for their diagnosis and treatment regimen. We are required by law to provide a Good Faith Estimate of what the cost to the patient will be.

Medicare approves treatment for proton therapy at Oklahoma Proton Center; thus, patients with Medicare can be confident that their treatment will be paid for. By law, Medicare Replacement plans have to offer the same coverage as Medicare, so patients with these plans will also have coverage, although a referral may be required.

How much does proton therapy cost?

As is often the case in healthcare, the answer is it depends. It depends on what your doctor prescribes in terms of how many treatments it will take to treat your disease. It will depend on your particular insurance plan. Medicare pays about $1,000 per treatment thus if a patient has a 20% co-pay, they would owe about $200 per treatment. A patient may receive anywhere from 5 to 44 treatments which is why the answer is, “it depends.” There are some additional ancillary charges related to the cost of the physician, imaging to prepare the patient for treatment as well as routine imaging during treatment, developing your custom treatment plan, etc.

If a patient does not have insurance, Oklahoma Proton Center offers cash pay rates that are the lowest in the industry. Oklahoma Proton Center is a not-for-profit healthcare provider that also offers a charitable care policy as part of its original charter. The center can provide need-based discounts or grants as well as structure payment plans that can help patients afford treatment. We do not want the cost of treatment to be a burden that prevents patients from receiving the care that they need.

Is proton therapy more expensive than other treatment options?

This depends on a number of factors, including where the other treatment is being provided and what treatment or treatments are being included. For example, Oklahoma Proton Center is a free-standing, independent facility, so the cost of proton therapy here can actually be less than traditional radiation treatment at a hospital that charges much higher rates. 

Chemotherapy, Immunotherapy, and other targeted therapies can often cost into the hundreds of thousands of dollars. The cost of a course of proton therapy at Oklahoma Proton Center can range from between $25,000 to over $100,000, once again depending on the answers to the question above regarding the number of treatments and the particular insurance plan of the patient. But still, much less expensive than some of of the other treatment modalities used to treat cancer.

Additionally, the “cost” burden of treatment isn’t just the cost of the treatment itself but also the cost of treating the side effects of the treatment. While proton therapy can be more expensive upfront than other types of radiation treatment, in the long run, the cost can be less due to the reduction in treatment-related side effects. 

In fact, a study from MD Anderson did in conjunction with the State of Texas employee health benefit plan showed that over a 6-month period, the total cost of caring for a proton therapy patient was less than the cost for a comparable patient receiving IMRT (photon-based radiation treatment). This was due to the reduction in treatment related complications for the proton therapy patients.

What else should I know?

Ultimately what is most important is that a patient receives the best possible treatment regardless of where that is or what that is, or what the cost is. That is why it is so important for patients to be their own advocates and do their research. A physician consultation is almost always covered by insurance and only takes an hour or two out of one’s day. A very small investment in what could be a life-changing decision. Every patient should explore all possible treatment options before making a decision. 

If you have a question about proton therapy, the cost, your insurance plan, or how proton therapy can work for your cancer, please call us at (405) 773-6700.

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