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What is the role of "the financial guy" at a proton center?

I have my initial appointment at a proton treatment center on Monday. I am told my last interview will be with "our financial guy". What can I expect? Is this merely a discussion of the difficulties we will face in getting approval for treatment from my insurance carrier? Will "the financial guy" be offering to assist or take the lead in getting approval and conducting any necessary appeals? Or is "the financial guy" someone who will be trying to get me to pay for the procedure out of my own pocket?

Re: What is the role of "the financial guy" at a proton center?

Basically it's his/her role to make absolutely certain the facility will be paid... one way or the other.

Re: What is the role of "the financial guy" at a proton center?

As Don says, this guy makes sure the center is paid for your treatment.
It's a refreshing change from most practices who schedule you for a treatment or procedure and don't give you the slightest clue what it will cost. The "financial guy" was the only non-medical staff I met on my 3 months at UFPTI. He basically goes over all the costs of the treatment(s)and what is covered by your insurance and what is not. In my case I had Medicare and a supplement, and it did not cost me a cent out of pocket (including 9 weeks of supplemental chemo). My friend had a Medicare "Advantage" plan that had a $30 co-pay each time he seen a doctor. As the result he had to pay a $30 co-pay for each of his 39 treatments ($1170 which they collect before the treatments began). I don't believe the "financial guy" will help you arrange financing. You are responsible for that. When I was initially diagnosed I had a BS/BC Advantage plan that refused to pay for proton treatment at all. I had to wait a year to get back on regular Medicare which covered the treatment.

Re: What is the role of "the financial guy" at a proton center?

Joe: thanks very much for the info. I am wondering if this person also plays a role in preparing the Preauthorization request and appeals to the insurance carrier. I have BCBS Illinois PPO, which has been considering dropping coverage for proton therapy, but has not quite done that yet, so I bet the company routinely denies the first request.

Re: What is the role of "the financial guy" at a proton center?

I know you asked Joe, but here's my two cents worth.
Its highly unlikely the "finance guy" will provide assistance in filing an appeal. If push comes to shove Bob Marckini and/or his organization will provide guidance in this respect. As you may know Mr. Marckini can be contacted at RMarckini@aol.com

Re: What is the role of "the financial guy" at a proton center?

As Don says, it is unlikely that the finance guy would assist on an appeal. However before you file an appeal, you have to be denied coverage and it sounded like you just had your "initial appointment" where they discuss the appropriateness of proton therapy. During your appointment with the "financial guy" on Monday, he/she will most likely be familiar with your insurance company and will be able to tell you the probability of coverage. I also suspect he will be able to direct you to appropriate resources to assist in any appeal should it be needed.

Re: What is the role of "the financial guy" at a proton center?

Thanks Joe and Don. I thought that getting a "determination of benefits" was going to require a medical school term paper, but the proton center near me had already obtained the determination from my insurance carrier by the time I arrived for my introductory appointment. The interesting thing is that this insurance carrier has announced that it is ending coverage of proton therapy on April 15. Since I have my predetermination of benefits in hand, I can get this coverage for this therapy as long as I start treatment by that date. So, at this point, I am trying to finalize my evaluation the relative merits of proton therapy and radical prostatectomy for my specific situation. Regards.

Re: What is the role of "the financial guy" at a proton center?

Great news! I will be surprised if UFPTI does not accommodate you on this issue. I would advise you to nail down your starting date ASAP. Provide us some feedback as you proceed. Best wishes

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