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Proton Beam Therapy denials: what the review data shows
Independent reviewers have decided 124 published cases where an insurer denied Proton Beam Therapy — and they overturned the insurer 26.6% of the time. A denial for Proton Beam Therapy is a starting position, not a final answer.
Published decisions
124
2001–2026
Overturned
26.6%
33 denials reversed
By condition
Published outcomes when Proton Beam Therapy was denied for these conditions.
| Condition | Decisions | Overturned |
|---|---|---|
| Prostate Cancer | 53 | 7.5% |
| Cancer | 16 | 62.5% |
| Breast Cancer | 12 | 8.3% |
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the outcome record for Proton Beam Therapywhen you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.