Insurance Execs Refused to Pay for Cancer Treatment That Could Have Saved Mich. Man. How They Did It: ProPublica

- 'Insurance Executives Refused to Pay for the Cancer Treatment That Could Have Saved Him. This Is How They Did It.' ProPublica, Ed. Nov. 15, 2023. 🥼

A Michigan law requires coverage of cancer drugs. One insurer came up with a “defensible” way to avoid paying for treatments that offered Forrest VanPatten his last chance for survival. “We crossed the line,” says a former executive. Forrest VanPatten was 50 and strong after years as a molten-iron pourer when he learned in July 2019 that a hyperaggressive form of lymphoma had invaded his body.

Chemotherapy failed. Because he was not in remission, a stem cell transplant wasn’t an option. But his oncologist offered a lifeline: Don’t worry, there’s still CAR-T. The cutting-edge therapy could weaponize VanPatten’s own cells to beat back his disease. It had extended the lives of hundreds of patients who otherwise had no chance.

And VanPatten was a good candidate for treatment, with a fierce drive to stay alive for his wife of 25 years and their grown kids. VanPatten didn’t know it, but he also had the law on his side. His home state of Michigan had long required health insurers to cover clinically proven cancer drugs. He and his family gripped tight to the hope that the treatment promised.

Then, his insurance company refused to approve it.

Across the US, health insurers are flouting state laws like the one in Michigan, created to guarantee access to critical medical care, ProPublica found. Fed up with insurers saying no too often, state legislators thought they’d solved the problem by passing hundreds of laws spelling out exactly what had to be covered. But companies have continued to dodge bills for pricey treatments, even as industry profits have risen. ProPublica identified dozens of cases...
Read More, https://www.propublica.org/article/priority-health-michigan-cart-insurance-vanpatten-denials
Hat tip to Thom Hartmann for covering this story.