Published in the Red Journal, this study analyzed 1753 patients with thoracic or head and neck (HN) cancer considered for proton therapy including 903 (553 thoracic, 350 HN) entered the insurance process, rates of and times to approval and successful appeal after initial denial were calculated. Approval rates by Medicare (n=538) and private insurance (n=365) were 91% and 30% on initial request.

Of the 306 patients initially denied coverage, 276 appealed the decision, and denial was overturned for 189 patients (68%; median time 21 days from initial inquiry). This study concluded that despite an 87% ultimate approval rate for proton therapy, the insurance process is a resource-intensive barrier to patient access associated with significant time delays to cancer treatment.