Westley Fong wasn’t supposed to live to see Christmas this year.
His oncologist told him there was nothing more he could do for a tumor behind Fong’s eye. His stage four cancer, in remission since 2003, had returned and spread to his lower back.
But Fong didn’t give up — he had heard about the Cyberknife, a radiation machine at the Cancer Center at Penrose Main Hospital. Although the hospital oncologist wasn’t part of Fong’s insurance network, he obtained approval for the treatment. And that may well have saved his life.
“It was three treatments on the tumor in my back and five for the one behind my eye,” he said. “And it was easy, simple and I had no pain.”
The first time his cancer was treated, the 35 radiation treatments during seven weeks robbed him of his energy, his sense of smell and his sense of taste.
“I wanted to end it, I wanted to die about half way through. My flesh felt like it was burning, it smelled like it was burning,” he said. “This time, I had a headache the first time, but I feel great. It was a cakewalk.”
But all cancer patients might not be as lucky as Fong.
Some insurance companies won’t approve Cyberknife treatments, particularly if the oncologist is out of network. Some claims have been denied because companies don’t fully understand the treatment and consider it experimental.
“Patients on an HMO plan might be limited,” said Susan Anderson, a registered oncology nurse who helps coordinate treatments and insurance reimbursements for Cyberknife patients. “But most insurance companies allow treatment because it is unique in the area. We deal with that part of it; patients don’t have to worry about dealing with their insurance companies.”
But reimbursement isn’t guaranteed, she said, and hospital rules require verification that insurance will pay for it before the treatments begin.
Penrose has treated 60 patients with the Cyberknife during the two months since it bought the technology. And so far, insurance companies have approved the treatment.
“I think it’s more acceptable just in the past year,” she said. “When we first got on board with the treatment, we were told there might be problems with approval. But it hasn’t happened.”
Some of the reasons for Penrose’s success are that the hospital is careful about which patients are selected for the procedures. As a full-service cancer center, other treatments might be more successful.
“Insurance companies say which sites they will pay for,” Anderson said. “So we know that in advance. And outside of insurance, it isn’t appropriate for every case.”
Insurers could be drawn to Cyberknife because it is cheaper than traditional radiation, Anderson said. Since a patient needs fewer treatments, the procedure doesn’t cost insurance companies as much.
Cyberknife uses the same technology that Mercedes-Benz uses to put tiny screws in its automobile. A robotic arm tracks the patient’s smallest movements, and delivers radiation directly to the tumor — and almost none of the surrounding, healthy tissue is affected.
Approved during 1998 for lung cancer, the Food and Drug Administration approved it for all tumors in 2001. Its success rate in treating cancers — particularly lung and brain tumors — is outstanding, said Dr. Allan Monroe, the Penrose oncologist who uses the system.
“Lung cancers used to have a survival rate of 25 to 30 percent,” he said. “With Cyberknife, you can treat the tumor even as it moves with the patient’s breathing. It raises the survival rate up close to 90 percent.”
And as the technology becomes more widely accepted, the problems with reimbursement will end. Until then, Monroe said patients have other options.
“It still leaves all the traditional treatments in place,” Monroe said. “Cyberknife will never replace surgery, and it isn’t used in all cases. We only use it in cases that we believe it will be beneficial. Other types of care can be indicated in some cases.”
Working with insurance companies
Accuray, the company that developed Cyberknife, offers the following advice to patients and providers about how to deal with insurance companies:
Know your health care insurance benefit plan administrator. Call and ask if your specific plan includes coverage for radiosurgery treatment.
Contact the medical facility’s reimbursement administrator assigned to your case. This person can advise you on how long it should take to secure the prior authorization for treatment, and be the point of contact for checking on the status with the insurance company. The administrator can also intervene on your behalf with the payer to explain the need for treatment.
If you experience challenges getting coverage for Cyberknife treatment, Accuray will work with doctors.