Proton Therapy Insurance Coverage

One of the first question many patients ask before coming to Oklahoma Proton Center is “what does proton therapy cost?” Or “will my insurance cover this?” We have answers to those and other questions below.

Is Proton Therapy Covered by Insurance?

Fortunately, insurance WILL cover proton therapy treatment for most patients. 

If your physician recommends proton therapy as the best option for your cancer then Medicare AND Medicare Replacement (Advantage) plans such as those offered by Blue Cross, UHC, Humana, and others will almost always cover treatment. 

If you have traditional commercial insurance through companies such as Blue Cross, Aetna, Cigna, etc. then coverage is based on the specifics of your insurance plan. Overall, Oklahoma Proton Center gets over 70% of commercial insurance plans to cover proton therapy for patients and for certain cancers and carriers coverage success is well over 90%.

Our team of financial counselors is specially trained to work with insurance companies to obtain the best coverage for patients and can answer any questions you have. They will handle the entirety of the pre-approval process on your behalf and can often turn an initial “no” into a “yes” by going through an appeal process.

We also know that with cancer time is of the essence. So, we work to expedite the insurance approval process so that you know the entirety of the situation with insurance and can move quickly toward the treatment you need.

What is the out of pocket cost for proton therapy?:

Out-of-pocket costs will vary depending on a patient’s insurance plan. Oklahoma Proton Center is in-network with almost every major insurance company and so patients are typically able to access their lower cost in-network benefits.

There is sometimes a misconception that proton therapy is “really expensive” or more expensive than other forms of radiation treatment. However, for most patients, there is no difference in their out-of-pocket cost for proton therapy versus other, less precise forms of radiation treatment such as IMRT. 

Additionally, most cancer centers in the Oklahoma City area are classified as hospital based while Oklahoma Proton Center is classified as a free-standing (rather than hospital based) medical provider. This means that for some patients their out-of-pocket costs are actually lower for proton therapy than they would be for traditional radiation treatment at a hospital-based facility.

Oklahoma Proton Center’s financial counselors will always provide transparency for your out-of-pocket costs, letting you know what you will owe for treatment before you start.

CHARITY CARE:

Sometimes, even with insurance coverage, and certainly in the rare instances where insurance coverage is not available, the out-of-pocket costs can place an undue burden on patients. We never want cost to be a barrier to accessing proton therapy as the best treatment option for your cancer.

Oklahoma Proton Center is a 501c3 not-for-profit charity and thus is able to offer a generous needs-based charity care program for Oklahoma residents. This can apply to deductibles and co-pays, and when applicable, to the full cost of care. 

Patients can apply for financial assistance and can receive partial or even full charitable benefit depending on their personal financial situation. Additionally, OPC offers payment plans in situations where charity care isn’t available.

If you have questions about OPC’s charitable assistance program or payment plan options, don’t hesitate to reach out to one of their financial counselors who can confidentially walk you through this process.

Financing Options

We know that sometimes the best option for patients can be to finance their out of pocket costs. There are a number of outside companies that provide medical financing. An option of what that could like along with a link to apply for financing is in the graphic. In some situations, Oklahoma Proton Center, as a not for profit, can provide payment plans for patients. If you have questions about financing options please reach out to Oklahoma Proton Center and ask to speak with a financial counselor.

Is Proton Therapy Covered by Medicare?

Proton therapy is typically covered by Medicare. Our financial coordinators can assist you in working with your insurance company to identify your benefits and obtain authorization.

INSURANCE COMPANIES IN NETWORK:

Oklahoma Proton Center is in network with most major payers including (but not limited to):

Note: If you do not see your insurance plan on this list, please reach out to Oklahoma Proton Center to find out if we are in-network or can obtain in-network benefits for a specialized service.