A Geneva<\/a> resident and Navy nurse veteran, Barbara and her husband Ed Strugalla went through some intense stress as their health insurance company, Aetna, denied the proton therapy<\/a> her doctor recommended as \u201cexperimental.\u201d <\/p>\n They appealed and it was denied again.<\/p>\n After a reporter contacted the insurer, Aetna approved the appeal \u2013 then denied that it was approved.<\/p>\n A few days later, they did approve it \u2013 and blamed Barbara and her doctor for not following the right process for their second appeal, according to an email from the insurer\u2019s spokesman.<\/p>\n \u201cAlthough the member and her doctor did not follow the plan appeal process<\/a> with respect to the original denial, Aetna itself initiated an expedited review by an external review organization (ERO),\u201d according to an email from Aetna spokesman Philip Blando. \u201cI\u2019m confirming that the procedure was, in fact, approved on June 12. Aetna strives to put our members first and we appreciate the value of external review in these complicated situations.\u201d<\/p>\n In an email statement the Strugallas wrote, \u201cWe are ecstatic that the insurance company ultimately reversed its decision and approved proton beam therapy.\u201d <\/p>\n \u201cOur family and friends have also been a tremendous source of encouragement and strength during this frightening and uncertain time,\u201d according to their email. \u201cWe are incredibly appreciative of the excellent, individualized care Barb is receiving at Northwestern Medicine.\u201d<\/p>\n While waiting during the appeal, Barbara suffered. She was in constant pain, in and out of the hospital for pleural effusion, a procedure to drain fluid build-up in her left lung, according to the Strugallas\u2019 email.<\/p>\n Proton beam therapy is a type of radiation treatment that precisely delivers a beam of protons to disrupt and destroy tumor cells. It can cost up to $200,000, but the couple said they never got an exact total of what her therapy would cost.<\/p>\n The Strugalla\u2019s adult children started a GoFundMe<\/a> while waiting for the appeal, eventually raising $15,338. <\/p>\n \u2018Not approved\u2019<\/p>\n Documents provided to the Kane County Chronicle show Barbara\u2019s doctor submitted a request for proton therapy June 1. <\/p>\n In a responsive text message the same day, Aetna denied the coverage.<\/p>\n \u201cYour prior authorization request was not approved,\u201d Aetna said in a written response to Barbara. \u201cWe base our decision on many factors. These include the quality, cost and safety of certain services and medications.\u201d<\/p>\n In a follow-up letter June 4, Aetna said, \u201cThis procedure is experimental or investigational under the terms of your plan … The plan does not cover experimental or investigational services listed in the Exclusions section of the benefit plan document.\u201d<\/p>\n \u201cMedical studies haven\u2019t proven that proton beam radiotherapy is effective to treat your condition,\u201d according to the denial letter. <\/p>\n Aetna\u2019s response stunned the Strugallas, as their previous insurer, Cigna, covered proton therapy last year for the same cancer.<\/p>\n What stunned them even more was what Aetna\u2019s medical director told Barbara\u2019s doctor during their appeal process: \u201cIf it is that advanced, then she should consider hospice care.\u201d<\/p>\n \u201cWe feel it is inhumane and cruel to deny life saving treatment for a paying insurance family and offering hospice care as an option instead,\u201d the Strugallas wrote in an email. <\/p>\n Blando denied the insurer said that.<\/p>\n \u201cImportantly, we did not suggest Mrs. Strugalla should stop treatment and enter hospice care at any point in this process,\u201d Blando said in an email.<\/p>\n Geneva resident Barbara Strugalla served as a nurse in the Navy. (Photo provided by Ed and Barbara Strugalla)<\/p>\n Barbara gave written permission for her doctor to speak with a reporter. <\/p>\n Northwestern Medicine\u2019s spokespersons said in an email that Barbara\u2019s doctor would not be available for an interview.<\/p>\n Proton therapy <\/p>\n Contrary to what Aetna asserted, proton therapy is neither new, experimental nor investigational.<\/p>\n The U.S. Food and Drug Administration approved it as a radiation treatment option in 1988.<\/p>\n Fermi National Accelerator Laboratory in Batavia is where proton therapy was first developed. (Photo provided by Ryan Postel)<\/p>\n And the fact that it was developed in the Fox Valley, at Fermi National Laboratory in Batavia<\/a>, made Aetna\u2019s reason for the initial denial a cruel irony for the Strugallas.<\/p>\n \u201cThe skeptics are being proven wrong,\u201d according to Fermilab\u2019s Proton Treatment Center Newsletter<\/a> of June 1993. <\/p>\n \u201cWhen physicists unveiled the proton accelerator for the first time in 1989 at Fermi National Accelerator Laboratory, physicians at Loma Linda, (Cal.) … predicted it would become a major tool in the war on cancer,\u201d according to the newsletter. \u201cProtons were first suggested as a potential cancer therapy in 1946 by Robert Wilson, who established Fermilab. Wilson\u2019s vision proved to be accurate.\u201d<\/p>\n Proton therapy can be directed at the cancer while sparing surrounding tissue, unlike conventional radiation, according to the Fermi newsletter.<\/p>\n \u201cTo avoid complications, physicians often lower radiation dosages to spare healthy tissue. But that can allow malignant cells to survive,\u201d according to the newsletter. \u201cProtons … go precisely where the physicians want them to go and no farther. So, while a tumor is being bombarded by protons, surrounding normal tissue is left intact; the patient is spared debilitating side effects.\u201d<\/p>\n Fermi physicist Don Lincoln, Ph.D., author and host of the YouTube channel Fermilab, also presented a video on how proton radiation therapy works<\/a> in 2017.<\/p>\n According to the National Association for Proton Therapy<\/a> website, the Northwestern Medicine Proton Center<\/a>, 4455 Weaver Parkway, Warrenville, is the first proton therapy center in Illinois and the ninth center in the U.S.<\/p>\n Northwestern\u2019s proton center, where Barbara is now receiving proton therapy, is 11.4 miles from Fermilab, where the therapy was first developed.<\/p>\n She will receive proton therapy through August, then will begin chemotherapy.<\/p>\n The couple will celebrate their 26th wedding anniversary on Dec. 16.<\/p>\n Proton lawsuits<\/p>\n Aetna has a history of being successfully sued for denying proton therapy to cancer patients.<\/p>\n The most recent was a $3.4 million class action<\/a> settlement in Florida last year for 71 claimants.<\/p>\n Another was the family of Orrana Cunningham, an Oklahoma woman who later died. Her family sued and won a $25.5 million <\/a>judgment in 2018.<\/p>\n![\"Geneva](\"https:\/\/www.europesays.com\/ch\/wp-content\/uploads\/2026\/07\/J76R27TC2JCRVDAU4BGJF62VCU.jpg\")
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