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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
