Guest guest Posted February 22, 2008 Report Share Posted February 22, 2008 Hi Sheila, we all know what an awful time this is for you and your husband. I do not think that Mass General is going to accept your husband. They state on their web site that one of the conditions they will treat with protons is early stage prostate cancer. I am thinking that with a Gleason 9 your husband does not fall into that category. What the nurse said to you about him needing to be a 6 or 7 probably will stand. If your husband is truly serious about protons you would nost likely have to travel to California or Florida. One of my mottos is the corny " where there's a will, there's a way " Gregg and I have heard from several folks who have had surgery because they felt they could not afford the time and or money to go for protons. We can understand the financial difficulty, but we always shake our heads over the time affordability thing? 10 weeks vs the rest of your life as far as quality of life. We don't get it. Keep asking your many questions. You always seem to get multiple answers. Laurel > > Hi everyone, > My husband was in touch with a doctor at Mass. General for Proton Therapy. His nurse told my husband that she didn't think my husband was a good candidate for the therapy because his Gleason number is 9 and they like it to be around 6 or 7, she told my husband to fax all his Lab reports and she would give them to the doctor and they would call us back. > Our insurance company will pay only 80% because the doctor is out of network, but that's better > than nothing. But we still don't know if the Hospital will except him. I'll keep you posted. It's all so frustrating. We just can't afford to travel to California or Florida for treatment, so if Mass. General doesn't take him he has surgery in May. > > > > . > -------------- Original message -------------- > > Hi folks, > I submitted my request for proton therapy to my HMO, and they denied > it because it is considered " experimental " . I welcome this, because > I think it's the easiest of all possible positions to refute. I've > written a short letter to submit via fax, today, to the Doc who > reviewed the case and made the determination. I am not making any > case at this time regarding the relative efficacy of proton therapy, > as that was not the basis of the denial. I don't think they can come > back with another reason if the " experimental " one doesn't fly...but > who knows? > I have always had good experiences with my HMO, but they are " behind > the curve " on this one. Please take a look at my first draft > response, and make any suggestions you can think of. > Thanks! > Dan > > Dear Dr. Ostrov, > > My request for coverage of Proton Beam therapy was denied > because " it is considered experimental " . > > Please reconsider this decision; > > 1. Proton beam therapy is FDA approved for treatment of prostate > cancer. > > 2. Medicare covers proton beam therapy for prostate cancer. > (Medicare does not cover " experimental " treatments.) > > 3. Proton Beam therapy has been offered on a clinical basis at Loma > University since 1990. They currently treat 150 patients per > day, and have treated over 8000 men for prostate cancer. There are > 4 other Proton treatment clinics in the US: University of Florida > Proton Therapy Institute, Midwest Proton Therapy Institute in > Indiana, Massachusetts General Hospital in Boston and MD > Hospital in Houston, Tx. > Prostate cancer is the most common form of cancer treated at these > facilities. > > Additional centers currently under construction or development are > Hampton University in the Tidewater VA area, University of > Pennsylvania Medical Center, Seattle Washington's Cancer Care > Alliance, Northern Illinois University, -Jewish Hospital in > St. Louis, Missouri, ProCare Treatment Center in Oklahoma City, > Broward General at Ft. Lauderdale and Orlando Regional at Orlando, > Florida, > > There are over 25 proton beam clinics worldwide, with 20 more under > construction. More than 50,000 people have been treated with proton > therapy worldwide. > > I respectfully submit that Proton Therapy is not " experimental " , > and as such, is not a basis for denying coverage. > > Sincerely, > > Me... > Quote Link to comment Share on other sites More sharing options...
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