Summary Priority Health Denied His Last Hope, CAR-T Cancer Treatment — ProPublica www.propublica.org
5,336 words - html page - View html page
One Line
Priority Health denied coverage for CAR-T treatment for a cancer patient, categorizing it as gene therapy in order to evade expenses.
Slides
Slide Presentation (7 slides)
Key Points
- Priority Health denied coverage for CAR-T cancer treatment to a patient named Forrest VanPatten.
- The treatment was VanPatten's last chance for survival against an aggressive form of lymphoma.
- Priority Health classified the treatment as a gene therapy rather than a drug to avoid paying for it.
- Former employees revealed that the decision was driven by the high cost of the treatment.
- VanPatten's family fought for coverage through appeals but were ultimately denied.
- Insurance companies are flouting state laws designed to ensure access to critical medical care.
Summaries
17 word summary
Priority Health denied cancer patient coverage for CAR-T treatment, classifying it as gene therapy to avoid costs.
72 word summary
Priority Health denied cancer patient Forrest VanPatten coverage for CAR-T treatment, despite Michigan law requiring coverage. The insurance company classified the treatment as gene therapy instead of a drug to avoid paying for it, citing high costs. VanPatten's family fought for coverage, but he passed away before an independent medical reviewer could weigh in. This case highlights insurance companies prioritizing profits over patients' needs and disregarding state laws for medical care access.
140 word summary
Michigan-based insurance company Priority Health denied coverage for CAR-T cancer treatment to patient Forrest VanPatten, despite Michigan law requiring coverage of cancer drugs. The therapy was his last chance for survival against an aggressive form of lymphoma. Priority Health classified the treatment as gene therapy instead of a drug to avoid paying for it. Former employees revealed that the decision was driven by the high cost of the treatment. Priority Health executives calculated that the monthly cost per policyholder would be 17 cents if they covered the treatment, but they chose to save money instead. VanPatten's family fought for coverage through appeals, but he passed away before the independent medical reviewer had a chance to weigh in. This case underscores how insurance companies are prioritizing profits over patients' needs and disregarding state laws that ensure access to critical medical care.
169 word summary
Priority Health, a Michigan-based insurance company, denied coverage for CAR-T cancer treatment to a patient named Forrest VanPatten. The cutting-edge therapy offered VanPatten his last chance for survival against a hyperaggressive form of lymphoma. Despite Michigan law requiring coverage of cancer drugs, Priority Health found a way to avoid paying for the treatment by classifying it as a gene therapy rather than a drug. Former employees revealed that the decision not to cover CAR-T therapy was driven by the high cost of the treatment. Priority Health executives calculated that the monthly cost per policyholder would be 17 cents if the expense was shifted to them, but instead of raising premiums or absorbing the cost, they chose to save money. VanPatten's family fought for coverage through appeals, but he was ultimately denied and passed away before the independent medical reviewer had a chance to weigh in. The case highlights how insurance companies are flouting state laws designed to ensure access to critical medical care and prioritizing profits over patients' needs.