Insurance denials for certain pediatric cancer treatments are generally overturned on appeal.
Insurance companies end up covering proton therapy treatment for pediatric cancer patients in 97 percent of the cases they originally deny once those decisions are appealed. Researchers from the Perelman School of Medicine at the University of Pennsylvania analyzed five years of coverage decisions at Penn’s Roberts Proton Therapy Center. They discovered that roughly one in 10 pediatric cancer patients are initially denied coverage for the cutting edge and costly treatment – yet nearly all patients ultimately get approval. They published their findings in Pediatric Blood & Cancer today.
Proton therapy has a few key differences from traditional radiation, but the main advantage is that the radiation beam itself stops when it hits its target as opposed to going all the way through the patient’s body. This means it can focus on attacking the tumor while sparing healthy tissue – something that’s especially important in pediatric patients, since radiation can impact development of the brain, spine, and other areas.
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