Answers to Your Proton Treatment and Insurance Questions
We understand that when you receive a diagnosis of cancer, you need to make many important decisions and may have a number of questions. Find your answers below or call us at 858.283.4771 to speak directly to one of our team members.
Proton Therapy Treatment FAQs
How long is a proton therapy medical consult?
Total appointment time can take several hours, including time required on-site to update your medical records and other information and time with a radiation oncologist for the consultation discussion.
What do I need to bring to my medical consult?
Please bring completed paperwork that was sent to you, as well as insurance card(s), imaging CD(s) and any other information requested ahead of this appointment. We will call you with a reminder the day before your consultation appointment.
What is a CT-Sim?
Short for “CT Simulation,” this is an appointment during which you are placed on a treatment table replica in the exact position needed for your specific tumor and tumor location. If needed for your treatment plan, a custom immobilization device such as a mask, headrest or other device is created.
How long does a CT-Sim take?
In general, this appointment will last one hour. It can require up to three hours if additional images are needed.
What is a V-Sim?
Short for “Verification Simulation,” this is when your treatment and setup are verified before the delivery of the first treatment (beam on) to ensure accuracy and precision of all calculations, measurements and patient positioning.
How long does a V-Sim take?
Approximately 30 minutes.
How long does creation of a customized proton therapy treatment plan take?
The average time for most patients is from 10 to 14 days once all necessary images and medical records are obtained.
How many proton therapy treatment sessions will I have?
The number of individual sessions depends on your type of cancer and location, as well as if treatment is concurrent with other treatments such as hormone therapy or chemotherapy. Please be sure to discuss any concerns you may have about pre-booked flights or other date-specific commitments with your care team.
How long is a proton therapy treatment session?
The average treatment session lasts 30 minutes, with the majority of time used for changing clothes and being prepped and positioned on the treatment table.
Why do I need a badge to check-in for treatment?
The system alerts the care team of your arrival.
Are pets allowed?
Only service animals specially trained to aid a person with a disability are allowed.
What is an OTV?
An “On Treatment Visit” is a weekly meeting with your radiation oncologist during your course of proton therapy treatment to follow progress and address any questions or concerns you may have. Your radiation oncologist may modify your treatment plan based on how your cancer is responding to treatment.
What phone number do I call to learn if the center accepts my health insurance plan?
858.283.4771 (Monday to Friday, 8 a.m. to 5 p.m. Pacific Time).
What happens once my proton therapy treatment is completed?
Your radiation oncology nurse will provide you with your medical discharge papers and after-care instructions. A bell ringing ceremony with your care team is traditionally held to celebrate your completion of proton therapy treatment.
How do I request my medical records?
Please call the center 858.283.4771 (Monday to Friday, 8 a.m. to 5 p.m. Pacific Time).
When is my follow-up appointment after completing treatment?
Follow-up appointments are typically discussed during your discharge process.
Are there other ways to be involved in the center during or after treatment?
Patients, family members and others interested in proton therapy can stay connected to the California Protons Cancer Therapy Center by becoming a member of California Protons Connect. Our members enjoy keeping in touch with other members and patients benefit from sharing their experiences, answering questions and providing emotional support to one another. You can also volunteer for our California Protons Champion Program to help support new and current patients, or attend an event or support group. Current and former patients plan social activities on a regular basis and post details in our center’s lobby. You can also stay in touch with patients and staff through our Facebook page at: facebook.com/CaliforniaProtons.
Proton Therapy Insurance FAQs
Does Medicare Cover Proton Therapy?
Medicare typically pays for 80 percent of covered services. In many cases, secondary Medicare insurance will cover the remaining 20 percent.
Which private insurance companies cover proton therapy and for what tumor sites?
Private insurance companies generally cover proton therapy on a case-by-case basis, depending on the type of tumor being treated, previous treatments, medical history and other factors. California Protons Cancer Therapy Center works with a variety of insurance providers, and our insurance specialists will work with your provider to determine your coverage.
How do I find out if my health insurance company will cover my proton treatment?
The first step is to schedule a consultation with a California Protons Cancer Therapy Center patient representative to review your treatment plan. Following your consultation, our insurance representatives can contact your insurance provider on your behalf to determine your coverage.
Call 858.283.4771 to schedule your consultation. Consultations are typically covered by insurance.
How does California Protons Cancer Therapy Center help me obtain approval for proton treatment?
While coverage is not guaranteed for every carrier, our representatives and physicians work directly with your insurance plan every step of the way, including:
- Responding to their questions
- Writing letters of medical necessity and submitting supporting documentation on your behalf
- Participating in peer-to-peer discussions regarding your treatment
- Providing comparative treatment plans
- When needed, submitting letters of appeal on your behalf
Even if my insurance covers proton therapy, how do I know what my out-of-pocket costs are?
California Protons Cancer Therapy Center insurance representatives will contact your insurance company to confirm your eligibility, benefits, deductible amounts and co-payments/co-insurance requirements. We will then determine how much your out-of-pocket costs will be.
What if my insurance carrier is out-of-state?
California Protons Cancer Therapy Center is contracted with many insurance companies outside of California. If we are not contracted with a provider, we will negotiate a letter of agreement for all approved services.
Can I get coverage for proton therapy if I change insurance companies?
If your current insurance provider will not cover treatment, you may be able to switch to another provider that does. However, private insurance companies generally provide coverage on a case-by-case basis. We do not advise changing insurance providers unless you have determined that your new provider will cover your treatment.
Is my proton therapy consultation covered by insurance?
In most cases, insurance companies cover the cost of the consultation. If necessary, we will assist in obtaining authorization to cover the consultation.
What happens if my insurance company denies proton therapy coverage?
In most cases, we will file an appeal with the insurance company on your behalf. If coverage continues to be denied, California Protons Cancer Therapy Center offers a cash payment plan at a significant discount.
How do I appeal to my state or state’s department of managed health care?
If your insurance company denies your appeals, they should send you instructions. In most cases, you are responsible for taking this step, as this request must come from the patient.
Are there actions I can take if my insurance carrier denies the appeal?
If the appeal is denied, you can take several steps:
- Seek help from one of the many nonprofit and for-profit entities that offer advice. Many states have health insurance consumer advocates.
- Talk to others who have had the same diagnosis and have been treated with proton therapy.
- Conduct Internet searches for people who have had proton therapy for your condition.
- Share your story on social media outlets to publicize your efforts and locate others who may be able to help.
If coverage continues to be denied, California Protons Cancer Therapy Center offers a cash payment plan at a significant discount.
For more information about proton therapy or to talk to one of our nurses, call 858.283.4771.