Specifically, the letter calls on insurers to clarify their peer-to-peer review processes by requesting specific answers to the following questions:

Does the company offer a peer-to-peer review with a patient's radiation oncologist and a physician reviewer with experience using proton therapy to treat patients diagnosed with cancer?
Does a physician reviewer have the authority to overturn an initial denial?

How often do physician reviewers consider cost in their decision making?

The letter also requests additional clarification on medical coverage policies for different insurance products (i.e. Medicaid, Medicare, exchange, and commercial) and uncommon diagnoses for which peer reviewed research is not available. Lastly, the Alliance is asking insurers to clarify their expedited review processes.

"Unexplainable discrepancies in insurance coverage, which inhibit physicians from prescribing and patients from receiving the most appropriate treatment for their illnesses, are far too common in the field of proton therapy," said Steven Frank, MD, Medical Director at The MD Anderson Cancer Center Proton Therapy Center and Alliance Board member. "If we wish to defeat cancer once and for all, all parties—both doctors and insurers—must finally unite in support of best practices such as proton therapy so that patients avoid facing frustrating and senseless denials for their prescribed cancer treatment."

A core set of patients' rights is the key tenet of the "Tell Insurers: Fight Cancer, Not Me" campaign. These rights are simply what patients should be able to expect from their insurance companies when faced with a cancer diagnosis. The goal is to help alleviate unnecessary emotional and physical stress when patients are denied treatment that has been recommended by their physician as the best hope for survival.

These rights can be achieved by demanding the following from health insurers:

Timeliness. Cancer patients deserve prompt answers about whether proton therapy treatment will be covered by their insurance provider.
Transparency. Cancer patients deserve a clear understanding of why their proton therapy is approved or denied by their insurer.
Fairness. Cancer patients deserve a fair determination of coverage for proton therapy, based on the recommendations and analysis of experts in the field, including the treating oncologist.

"When my brother was diagnosed with a brain tumor at age 23, he was regarded as an excellent candidate for proton therapy due to his age and his general prognosis, yet our insurer refused coverage, leaving my family stressed and confused by the complex insurance process. Despite our insurance company's refusal, we moved forward with the proton plan that his doctors assured us was the best course of care to eliminate his cancer and protect his quality of life," said Megan Niese, an Alliance advocate and board member. "While my brother has completed treatment and is doing great, my family is paying out of pocket through a payment plan for proton therapy that absolutely should have been covered by our health insurer."

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