Left Side Proton Radiation Therapy United Healthcare Approval?

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DD17
DD17 Member Posts: 13
edited April 2018 in IDC (Invasive Ductal Carcinoma)

Hi Fellow Healers and Warrior Women,

I recently had a mastectomy on the left side and reconstruction surgery. I have invasive DCIS Stage 2B high risk due to one lymph node with cancer. Because of this lymph node, I am in need of radiation and my dr is advising me to get PROTON radiation VS traditional PHOTON radiation. I agree with his recommendation for many reasons.

I live in the state of Va and my UNITED PPO insurance has declined payment (2x) for PROTON radiation although it is the exact same cost as traditional Photon radiation. I am in need of proton because it protects my heart and lungs better than photon radiation. If you are not aware of PROTON radiation, you might want to research it because it is much safer than PHOTON radation. I am seeking treatment at the MD Proton Center in Baltimore-the doctors and team are beyond fabulous.

I would like to know if there are any women who have been approved for PROTON radiation in the state of Va who have United Healthcare. This treatment is better and I am facing a $40k out of pocket cost :(. I entered into a trial to prove that this treatment is better than photon. I would like to hear from my fellow sisters and warrior healers.

Best,

DD17 Healing Strong

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited April 2018

    Back when I was considering all the possible scenarios - I looked into proton radiation at Baltimore as well. My insurance (Aetna Open Access) denied it.

    I really think it will be the choice in the future. It's already preferred for head and neck treatment as well as pediatrics.

    Thank you for participating in the trial. Are they not covering your costs?


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  • DD17
    DD17 Member Posts: 13
    edited April 2018

    Good morning,

    Thank you for letting me know your thoughts. I truly appreciate it. No, insurance will not cover the costs and my doctors have been so proactive as they have been through this many times. I agree, the Georgetown MedStar just opened their proton center and INOVA Fairfax hospital is opening theirs in 2020. It will be the treatment of the future I am sure of that too.

    No, the trial is not paid and requires pictures and blood and other tests to prove this treatment is better. I am the first to enroll through INOVA Fairfax hospital as my doctors also practice there. I am patient 17 at the MD Proton Center. I had my planning session there 12 days ago and signed up for the trial to help others froward not have to deal with this on top of the healing and recovery. We are going through one more round with insurance which is why I reached out here.

    I hope you are healing well. :)

    Best,

    Denise

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  • shelabela
    shelabela Member Posts: 584
    edited April 2018

    i was able to have Proton therapy. I'm not sure what my dr all did to get it passed. I had my whole left side and under arm radiated.

    Good luck. I also signed up for a trial.

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  • DD17
    DD17 Member Posts: 13
    edited April 2018

    Thank you so much and I am glad you got yours approved. I hope you are healing well and feeling good. Do you happen to have United Healthcare Insurance PPO?

    I am happy you signed up for the trial too. Thank you again for reaching out. :)


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