HAMPTON, Va. (WAVY) — For thousands of cancer patients, access to insurance coverage for proton therapy is a matter of life and death. However, so many patients find themselves locked out as insurance companies still refuse to provide them coverage for this lifesaving treatment modality, according to the Hampton University Proton Institute.
Hampton University Proton Institute is now calling for insurance companies to cover proton therapy for cancer patients. They called for a news conference centered around alleged constant denial of coverage for proton therapy for cancer patients. At that conference, cancer patients and doctors alike spoke about the need for proton therapy and the need for coverage. According to experts, the treatment can cost $100,000 without coverage.
Jack Weber’s wife Dianne is battling Stage 4 anal cancer and her doctors recommend proton therapy. However, according to documents provided by Weber, his provider — Anthem Blue Cross Blue Shield of Virginia — denied coverage.
Documents show her appeal was denied a week later. Their reasoning: Proton therapy is experimental.
So, he did his research and cites a Virginia law.
After a long battle at the Virginia Capitol, the Virginia General Assembly passed a bill in February making it illegal for insurance companies to hold proton therapy to a higher standard than other forms of cancer treatment — such as traditional radiation and chemotherapy — in their coverage determination. This bill, sponsored by Delegate David Yancey (R-Newport News), Hampton University President Dr. William R. Harvey and Bill Thomas, the Associate Vice President of Governmental Relations at Hampton University, emphatically said, “You can’t put a price on someone’s health.”
“It’s not just about my wife. There are cancer treatments throughout the Commonwealth who are being denied treatment by insurance companies and it’s happening over and over again and if you don’t know how to fight, if you are too weak and you don’t have the resources, then you probably aren’t getting the coverage and treatment you need and you are entitled to under your policy,” said Weber. “She’s a fighter and that’s why I married her.”
Dianne and Jack Weber, along with a number of other Virginia residents who feel they were blocked from receiving the best possible treatment for their cancer by their insurance carrier solely due to monetary reasons, attended Thursday’s press conference to tell their stories and fight back.
“These insurance providers in the Commonwealth of Virginia are still refusing to cover proton therapy, period. Enough is enough,” Bill Thomas said.
At the end of the press conference, Weber was informed that the decision by the insurance company was overturned and his wife Dianne would receive coverage.
10 On Your Side received a response from Scott Golden, Director of Corporate Communications with Anthem Blue Cross and Blue Shield:
Each year, loved ones, family members and friends are impacted by cancer. We want to help ensure our members battling this disease have access to safe and effective, evidence-based medical treatment that improves health outcomes. Ms. Weber’s case was reviewed by Anthem and two independent doctors. Subsequently, it went through a review process administered by the Virginia Bureau of Insurance and her treatment was approved. Unique situations like this are why we have our appeals process in place. We are pleased the treatment Ms. Weber was seeking will be a covered benefit under her Anthem health insurance plan. We will be happy to work with Ms. Weber should she run into difficulty scheduling her treatment given the circumstances surrounding Hurricane Harvey and its impact on Houston.
As with all laws affecting insurance coverage, we are fully aware of and have reviewed Virginia’s recent Proton Beam Radiation Therapy legislation and resulting statute. We previously implemented all necessary steps to comply with the law, and will continue to operate accordingly when it comes to making coverage decisions for our members.”