SPARTA, Mich. — FOX 17 first brought you the story of Forrest VanPatten, a 50-year-old man who died fighting with his insurance company to cover a potentially life-saving treatment in February of 2020.
VanPatten needed, according to his doctors, CAR-T treatment.
His insurance, Priority Health, didn't cover it even though Medicaid and Blue Cross Blue Shield did.
FOX 17 spoke with ProPublica reporters on Wednesday— who uncovered why Priority Health said no.
According to the report, internal communications obtained by ProPublica showed the back-and-forth discussions over whether or not CAR-T treatment could be denied, going back years before Forrest VanPatten's death in 2020— with a former high level executive saying it was all about the cost of the treatment, not about saving a life.
“It’s my only chance,” VanPatten told FOX 17 in 2020.
VanPatten was told— after years of fighting lymphoma— his only hope for extending his life was a CAR-T treatment; however, Priority Health didn't cover it.
“Everything that gets processed through the insurance company is just a rejection, rejection rejection,” VanPatten said before he passed.
Now, a report from ProPublica is shedding light on why VanPatten's cancer treatment wasn't covered. Scripps News also partnered with ProPublica on the publication.
READ MORE: How an insurer abandoned a cancer patient in his most critical hour
“It really is about understanding the why, of why this particular patient ended up being denied coverage for the care that he was seeking,” Robin Fields, a reporter for ProPublica, said.
Their investigation uncovered what some might consider to be the inevitable answer: the treatment that could have extended VanPatten's life is expensive, costing as much as a million dollars. According to former Priority Health executives, cost was the reason the treatment was not approved.
“That’s where he told us he felt like the insurer, Priority Health, really crossed a line,” Maya Miller, a reporter with ProPublica said.
Priority Health now covers CAR-T treatment, but didn't back in 2020 when VanPatten was sick, issuing FOX 17 the same statement it sent ProPublica.
“When the FDA first approved CAR-T cell therapy, there was a lack of consensus in the medical community regarding the treatment. Major life-threatening complications and side effects were common, with a high rate of relapse.” a Priority Health spokesperson said.
Reporters for ProPublica say it's their hope that knowing why this happened will help the VanPatten family as they continue to grieve, and encourage others to challenge the process when their insurance company issues a denial of coverage.
“The pain of losing someone was compounded by this anger, is what they told us. He didn’t really have a chance to see his last treatment option through,” Miller said.
Michigan law requires cancer treatments to be covered by insurance, but according to ProPublica's reporting, Priority Health initially classified the CAR-T cell therapy as a gene therapy, not a cancer treatment, using what family of Forrest VanPatten called a "loophole" to get around covering the treatment.
