Proton Therapy Billing & Insurance Coverage

Insurance Coverage for Proton Therapy

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Insurance Coverage for Proton Therapy

Scripps Proton Therapy Center has a dedicated team of patient representatives who work with insurance carriers on your behalf to obtain authorization for your treatment. 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 as required

Scripps Proton Therapy Center works with a variety of insurance providers. Because coverage varies depending on your insurance provider, condition, medical history and other factors, we recommend that you contact the center to speak directly with an insurance specialist.

  • Full coverage: In most cases, proton therapy is covered by Medicare (non-HMO). Patients covered by private insurance or Medicare supplemental insurance often incur few or no net out-of-pocket expenses after deductibles, copays/coinsurance and annual maximum payments are met.
  • Case-by-case coverage: Some insurance plans consider proton therapy on a case-by-case basis. In this situation, our team of specialists, including Scripps Proton Therapy Center physicians, work directly with your insurance plan to seek authorization for care by providing appropriate documentation to support the medical necessity of treatment.
  • No coverage: For those without insurance, and for international patients without insurance coverage in the United States, the center also offers reduced self-pay options and payment plans.

Proton therapy cost and long-term impact

Proton therapy may not be more expensive than other cancer treatments.

While the cost per daily proton dose may be slightly more expensive, the long-term cost may be much less as patients may experience fewer side effects that require treatment or medication. Additionally, recent studies have evaluated the cost of proton therapy to be lower when compared to other treatment options.

For patients covered by insurance and whose deductibles have been met, the cost of proton therapy requires little if any out-of-pocket expense. The cost for treatment varies by the actual number of treatments needed to treat the tumor.

Download the Scripps Proton Therapy Center Insurance Coverage Information to learn more. (PDF, 140 KB)

Studies report that:

Patients experience fewer short-term side effects with proton therapy.

  • In one study, women treated with X-ray radiation treatment had a risk of pneumonitis of 14 percent compared to a less than 1 percent risk with proton therapy.
  • The same study found that pneumonitis caused by radiation treatment costs more than $2,000 per occurrence.

Patients experience fewer long-term side effects such as secondary cancers with proton therapy.

  • For example, a Swedish study found it was eight times less expensive to treat adverse reactions than with X-ray radiation treatment.