From the Horse's mouth [we hope] so to speak. I certainly appreciate and am impressed by all the thoughtful commentary presented here and do not dare go off subject in defense of Ron Paul...
Regence's denials are based on it's own policy and NCCN Guidelines, but in those guidelines for prostate cancer patients, it states on page 55: Curative treatment options for all men with intermediate-risk prostate cancer consist of external beam radiation therapy or prostatectomy. And it refers back to a chart on page 46 showing the EBRT should be delivered with image guidance. CyberKnife, fits that description to a tee – but is NOT named - and yet Regence argues it's investigational.
This is my first ever commentary of any subject in a forum such as this and although not certain as to how it works, I suspect and hope the reply’s [of which I made a few] may be sent to you personally. If I'm wrong, I'll repeat why I don't feel I'm throwing a tantrum here: As a state employee, I've been with the Uniform Medical Plan since July of 2000 and they had a history of paying for CyberKnife thru December 31, 2010. Our Health Care Authority hopefully made a dreadful mistake by signing a four year deal with Regence Blue Shield to administer the Plan beginning January 1, this year. Neither the supervisor of the billing department or of the Financial Counseling department where I work saw this coming. Walgreens sent away a significant number of prescription medicine customers rather than dealing with Regence and I did in fact inquire about them with one who I mistakenly felt would council me correctly in their regard. I believe Uniform created an obligation to pay for CyberKnife and that is not charity – although I have looked into financial aid...
So do I! But here's what I've been able to find out. Surgery alone costs about 30K. What of the costs after the fact if you're lucky enough to live through it without infection etc? I don't have a clue but I would think someone somewhere would. CyberKnife, about 55K, with few to no additional costs. IMRT, which Regence approved for prostate cancer this August comes in at 10 to 15K more than CyberKnife at 80K but, you go in forty times to have the cancer and healthy tissue exposed to radiation and again there are many uncertainties as to follow up costs.
Here's just a friendly update: Accuray Inc., the manufactures of CyberKnife, successfully completed acquisition of TomoTherapy Inc., on June 13, 2011 and now can claim to date, more than 200,000 patients worldwide have been treated using the company’s technologies and more than 550 systems have been installed in leading hospitals around the world. 85% of all their European locations specialize in prostate cancer but Regence still presumes it to be investigational? And as Dr. Meier said in the report there's been so much new information that has come to light in just the past six months as to bring CyberKnife into the realm of 'standard care'.
Yes, I sure look older than I feel or am for that matter. And that goes for the rest of your post...
I too regret your loss. It's a wonder that Regence would cover anything at all. A 1988 case, Reilly vs. Blue Cross and Blue Shield United of Wisconsin, a case involving coverage for in vitro fertilization (IVF), an expert witness stated, "I think that like all of medicine, it (IVF) is always investigational and experimental in the sense that we have a potential for doing better and should investigate that potential." Or another, Rollo vs. Blue Cross Blue Shield of New Jersey, involved a suit over denial of coverage of autologous bone marrow transplantation. The court discussed the issue of investigational as follows: "Certainly, every treatment that does not have a hundred percent cure rate is open for improvement and, thus, has somewhat of an investigative or experimental component. Certainly, too, data from the treatment (the patient) will undergo will be accumulated and analyzed to improve yet once again what is known and, thus, in this respect as well, the treatment has an investigative or experimental component, as does any treatment as to which data is being compiled."
It could have been better stated but navidog does make several valid points.
Repeating: As a state employee, I've been with the Uniform Medical Plan since July of 2000 and they had a history of paying for CyberKnife thru December 31, 2010. Our Health Care Authority hopefully made a dreadful mistake by signing a four year deal with Regence Blue Shield to administer the Plan beginning January 1, this year. Neither the supervisor of the billing department or of the Financial Counseling department where I work saw this coming. Walgreens sent away a significant number of prescription medicine customers rather than dealing with Regence and I did in fact inquire about them with one who I mistakenly felt would council me correctly in their regard. I believe Uniform created an obligation to pay for CyberKnife and that is not charity – although I have looked into financial aid...
CyberKnife SBRT isn’t a radical departure from older radiation technologies It's the fine precision tuning of Radiotherapy. CyberKnife offers state of the art image guided technology that will give me the best chances of fighting the disease but also preserving my urinary, rectal and sexual function and overall quality of life.
Thanks Nancybratt! Johns Hopkins finally fessed up to forty years of evidence and stated yearly on this year that diet is seen as the cause of 90% of the prostate cancer it sees. That was the first thing I changed after discovering the cancer. Ever heard of itraconazole, a prescription med used to fight toenail fungus - according to a recent report from the Prostate Cancer Foundation - it also contains/confines cancer to the prostate - good thing my pinky toe has it and yet, Regence Blue Shield, also made me get a preauthorization for that too! In addition to that anti-fungal I alternate weekly doing either 11 or 12 supplements designed to strengthen my immune system and to actually attack the cancer itself, so I refute allegations of Russian Roulette. And the HTA was scheduled to investigate SBRT a/k/a CyberKnife [amongst others] this year. It's now on for early next year and as a Stakeholder, they will keep me informed.
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Experiment