As CIGNA Insurance Waffles On Liver Transplant, Girl Dies

CIGNA denied a girl’s liver transplant, saying it was “experimental,” then changed it’s mind after 150 family, friends, and nurses association members protested outside CIGNA headquarters. But the reversal was too late, Natalee Sarkisian, 17, died last night at UCLA medical center. The insurance company had initially agreed to pay for the liver transplant, but then after Natalee developed a lung infection, then got a bone marrow transplant from her brother, delayed, and then denied coverage, the family says. She was in a vegetative state, battling leukemia. In an email sent out shortly before Natalee died, the insurance company wrote, ” … CIGNA HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant.” Score another one for the bean counters.

Philly Insurance Company Changes Decision Hours Before Teen’s Death [NBC10]
Girl dies while awaiting liver transplant [ABC7] (Thanks to Dan!)

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  1. drrictus says:

    I know insurance is a scam, but this is…. sad.

    My condolences to her family.

    Do you think the bean counters at the insurance companies actually keep such a scoreboard in their offices? My expectations for people just got lowered some more, and I wasn’t sure that was possible.

  2. Jaysyn was banned for: http://consumerist.com/5032912/the-subprime-meltdown-will-be-nothing-compared-to-the-prime-meltdown#c7042646 says:

    Criminal Negligence. What Braveheat got is too good for insurance beancounters.

  3. humphrmi says:

    I’m sure many (including myself) will be outraged, and Cigna will undoubtedly (and deservedly) endure an onslaught of media attention for a while, and possibly litigation later.

    But I think here’s the salient point in their statement that summs up what is the problem with managed care in America:

    CIGNA said in an e-mail statement before she died that there was a lack of medical evidence showing the procedure would work in Nataline’s case.

    So basically now you need evidence in order to get life-saving care, as if your insurance company is some court of law that requires evidence before it can make a decision.

    That’s just plain wrong.

  4. dreamcatcher2 says:

    Wow… I wonder if this is a deliberate strategy in the insurance company playbook. “Waffle over coverage until patient passes event horizon; promise to pay for treatment only when sure patient will die before receiving said treatment.” Disgusting…

    Private health care is not the answer, as long as the nature of treatment is dictated by what is most profitable, things like this will continue to happen. (I don’t think public health care is the answer either though – what kind of hybrid strategies do you guys recommend?)

  5. pegr says:

    Um, would it be inappropriate to suggest that the young lady was already too far gone? I certainly don’t know, but if she was already so sick that a transplant would have only delayed the inevitable, the insurance company was right to deny coverage. Still, I sympathize with the family.

  6. whoneedslight says:

    And once again, cue the Lee Greenwood music….

  7. Falconfire says:

    Unless Im mistaken Liver Transplants are very common… hell even heart transplants have gone from once a few months to 2-3 a day by one doctor…

    Where the hell do they get off calling this “experimental” treatment.

  8. morganlh85 says:

    @drrictus: According to Sicko, they actually get rewarded for denying care. I don’t know how they sleep at night.

  9. Daemon_of_Waffle says:

    It is not that they need evidence per se. They just need the procedure to be a success before they pay for it. So, sure get the transplant. If you live, maybe we’ll pay for it. If you die, well, then you’re sol.

  10. bravo369 says:

    I don’t care whether the chance of success in a terminal patient is 2%. That’s why I have health insurance and they should be paying my bill. I just can’t imagine sitting in a hospital bed with doctors trying everything they can and being held up by an insurance company that i’ve paid thousands to over the years who is unwilling to help.

  11. savvy999 says:

    Accountant’s spreadsheets are an increasingly common cause of death in America; insurance companies simply cannot afford to let everyone live.

    Pathetic.

  12. burgundyyears says:

    I can’t wait until government bean counters make these care rationing decisions instead. All the bean counting with the added bonus of lawsuit immunity.

  13. teapartys_over says:

    @pegr: I was wondering this too. But maybe at the point when the transplant was recommended, she wouldn’t have been too far gone. It seems like doctors wouldn’t recommend a procedure unless they thought it had a chance of working. Otherwise it’s a liver that could go to someone else.

  14. mwdavis says:

    “Beancounters?” Much too nice a term.

  15. drrictus says:

    @morganlh85: Robots don’t sleep.

  16. sunchief32 says:

    A) She was in a vegatative state
    B) She had leukemia

    A liver wouldn’t have helped her. She should have never been listed for a transplant in the first place. Organs are a precious commodity and to give one to a person who most likely wouldn’t survive anyway means taking a liver from someone who has a chance at a relatively normal life. It’s a tough situation but it seems like the Dr.’s were giving this family false hope

    * Disclaimer* My opinion is based entirely on the few facts given in the article. It could be much more complicated.

  17. Brad2723 says:

    But would the liver transplant have saved her life?

  18. Jean Naimard says:

    They soundly sleep at night with the sleep of the little peon satisfied of a job well done. They are not paid to have a social conscience, they are paid to save their employer’s money, and the pay they take home is the only thing that counts.

    It’s still an early thread, but let’s see the subsequent fight between the proponents of an universal federal public health-insurance system and the diehards who would never pay for someone else’s health-care.

    As usual, the money will generate the biggest assholes.

  19. AstroPig7 says:

    @pegr: Honestly, all surgery is just delaying the inevitable.

  20. drrictus says:

    I wonder if today some CIGNA accountant is running around the office like Jack Lemmon in “Glengarry Glen Ross”:

    “Get the chalk!”

  21. JustAGuy2 says:

    In fairness, there need to be some standards, and some things that whoever pays for our health care (gov’t, private payer, whatever) just won’t pay for.

    We can’t be in an environment where everyone gets every possible procedure, regardless of cost and chance of success. Take it to an extreme level: what if there was a procedure that cost $1 trillion that would extend the life of 1 person by 5 minutes – would it be worth it? Clearly, this is an absurd example, but the point remains that, if a health care system is to function, determinations need to be made about what’s worth doing and what’s not.

    I know nobody wants to talk about cost/benefit analysis, particularly when it’s their own family, and I’m not claiming that I’d be unbiased either (if it were my sister/daughter, damn right I’d want it done).

    As a matter of public policy, however, health care (like anything else) can’t be unlimited and free. In countries that have single payer health care (which generally works much better than here), they just won’t do certain procedures, given the circumstances, because the cost/benefit isn’t there.

    I’m not sure if that news is easier to take if it comes from the gov’t rather than a private company, maybe it is.

  22. Charles Duffy says:

    @bravo369: There are only so many available organs. Doesn’t it make more sense to give the transplant to someone more likely to survive?

  23. pegr says:

    @teapartys_over:
    As I said, I don’t know for sure. But who might have the better perspective in regard for a procedure’s success? A doctor can read and evaluate, but can he/she really know the statistical answer?

    On the other hand, the insurance company has the numbers and really knows the chance for survival, yet are in a position to reduce expenses by denying coverage, even when the chance for success is high. They are motivated to protect their financial interests above the interests of their policyholders. Unless the criteria for denying coverage is absolutely transparent, they will be accused of choosing profit over the well-being of their policyholders every time.

    Add to this, the insurance companies cannot reveal the criteria for denying claims, as it is a valuable trade secret that, if competitors knew it, could be used against them.

  24. EricaKane says:

    Yeah, universal health care! Let some bureaucrat decide!

  25. EricaKane says:

    The insurance company would have been better off sticking with their original decision, now they are going to get their but sued.

    The lady had leukemia. Thats what happens when you have that, your organs fail. As far as I know leukemia isn’t a specific organ cancer, its pretty much all over your body. So you are telling me that getting a new liver will solve this lady’s problems? No she still has leukemia.

  26. reykjavik says:

    The American way is to waste all your years and time making sure a major corporation makes even more money. If we have to give our children to that cause then so be it. We gave four thousand of them to President Haliburton, didn’t we? The only real shame is that we aren’t giving more of our children to major corporations. For instance, Verizon only made 9 billion in profit last year, thats practically bankruptcy! The injustice must end. There must be someone out there willing to sacrifice their child for Verizon and other major corporations. If you don’t, you’re simply a bad American.

    Lets hang an American flag over Natalee Sarkisian casket because she’s technically the greatest American that ever lived. All of you will just give some cash to make our corporate CEO’s billionaires, but she gave her life! I’m sure when CIGNA CEO is on his yacht with a hooker doing coke, I’m sure he’ll be thanking Natalee Sarkisian for being such a great American.

    From every CIGNA shareholder and CEO: God bless you Natalee and the Sarkisian family (and thank god youre gone, as that would have cost like a few grand to save your life).

  27. drrictus says:

    @sunchief32: By my reading of the article, this was the sequence of events:

    1. Her liver failed
    2. Medical doctors prescribed the transplant
    3. CIGNA said no
    4. CIGNA said yes
    5. Her condition worsened, transplant was *NOW* no longer an option

    In other words, your medical opinion is based on her condition at Step 5, not Step 2, which is where the doctors made their decision.

    I vote for the doctors.

  28. selectman says:

    @sunchief32: Why the HELL is the insurance company the sole arbiter of such a decision? If her doctors determine that a liver transplant could save her life, SHE SHOULD BE COVERED. I agree completely with Humphrmi – it’s a sad state of affairs when insurance companies second guess life and death health care decisions.

    If she was your daughter and the doctors told you there was a X% chance that a new liver would save her, how would you feel if the insurance company decided that X% was just not good enough to make it worth their money? This is why we have insurance people – to make sure we still receive treatment when hit with a medical disaster!

  29. mattpr says:

    @whoneedslight:

    Because it IS an experimental treatment in this case. Just because transplants work with people with cirrhosis does not mean it’s going to work on someone with terminal leukemia. ENTIRELY different pathologies.

    Judging from the article(s), she likely only had a few days to live anyway, and the transplant was designed as a last-ditch effort even though there is very little evidence that this works with someone in her case.

    While what CIGNA did was horribly crass, they were NOT factually incorrect with their assessment of the case.

  30. bravo369 says:

    @Charles Duffy: I think that’s a decision usually taken into account when a person is placed on a donor list and a match is found. They aren’t going to give a heart to someone who’s a day from dying from something else. I assume that since they wanted insurance to pay for it, a match was found, she was deemed as an appropriate recipient and will live longer because of it.

  31. erratapage says:

    @pegr: That’s a decision that should be made by her care givers and her family–not the insurance company.

  32. Captaffy says:

    Why do people think that bureaucrats will get to decide if you get the transplant or not? Here in Canada (gasp!), you get the transplant assuming there is an organ available. Nobody, other than a doctor, would decide that there’s no point to doing it.

  33. burgundyyears says:

    @selectman: It’s the nature of health care. You can’t have it all. Either a private company is going to make these decisions to deny certain operations or types of care or a bureaucrat will.

  34. burgundyyears says:

    @Captaffy: Yes, but who decides who gets which organs that are available? Certainly some people die without ever receiving a transplant. All health care is rationed, no matter what kind of health care system you have.

  35. whoneedslight says:

    @mattpr:

    I still don’t think that’s a rationale for caregiving. Words like “likely” and “someone in her case” are not what I would want to hear if she was a loved one/family member. Insurance companies shouldn’t be making decisions about who lives and who dies. That would be like someone getting shot in the chest during an armed robbery or something. Chances are pretty good that he/she is going to die… should I really even bother calling the ambulance? That ambulance might be better utilized picking up someone who has a better chance of pulling through.

  36. missdona says:

    @Captaffy:
    To answer your question, I cannot trust my government to be efficient or fair. I do not trust the security they provide at our airports and I shudder at the thought of them controlling my healthcare.

  37. Murph1908 says:

    I can’t believe nobody has said this yet.

    Why wait for the insurance to say they’ll pay? Get the procedure done, fight the insurance later!

    But JUSTAGUY is absolutely right. Ask any politician in favor of government health care how they plan to handle the ‘rationing’, and they’ll avoid the question like the plague.

    You won’t be able to give every procedure to every patient. Somebody will need to decide if the 94 year old smoker gets the heart and lung transplant.

    You want to do something about the affordable availability to everyone, take a medical approach at it. Cure the DISEASE, not the SYMPTOM. You can’t fix this issue by paying or subsidizing the costs for people, you have to address the issues that have caused the costs to increase at a rate much higher than inflation over the past decade. Tort reform, caps on lawsuits, and ending the burden on our system by illegal immigrants is the first step.

  38. Dashrashi says:

    God, not to defend CIGNA, but it looks like she was really sick–first they did agree to pay for it, but then she got a lung infection, and then a bone marrow transplant? And all this from leukemia as the underlying cause? Again, I’m not a doctor and I don’t know all the relevant medical facts, but it seems like this poor girl was on her way out. I think it’s possible she was on the liver transplant list before her condition worsened, and it’s also possible that had she not been on the list before it did, her doctors might not have indicated a liver transplant at all. In which case, in her worsened condition, a liver transplant was not called for after all.

    Just saying it’s possible, and perhaps we should refrain from judging the situation just yet.

  39. Judes says:

    I’m with Murph1908 (well, his first two sentences, anyway). The doctors should’ve done it and the hospital should’ve taken the risk that they’d have to eat the cost.

  40. Captaffy says:

    @burgundyyears: I don’t know how the list works specifically. Obviously people with a greater chance of survival get placed at the top of the list, likewise children are placed higher than the elderly. But that’s beside the point. It will NEVER be a case of an organ being available but not given because the patient can not pay, or because the insurance company refused to pay.

    Why this system of insurance companies that seem to make it a practice to refuse care is tolerated, I will not understand.

  41. dodonnell says:

    Hey copyeditor, you missed an obvious one:

    “CIGNA denied a girl’s liver transplant, saying it was “experimental,” then changed _it’s_ mind after 150 family, friends, and”

    Insurance companies aren’t around to provide care, they are around to provide profits for their shareholders, and we are all complicit in their many failures because we created and support the system. If you really think there is a more compassionate, efficient, and effective way to provide health care in the United States, then put actions behind your thoughts and words and get the government to change it.

  42. Captaffy says:

    @missdona: I don’t trust my government either, but I do trust them more than a publicly traded insurance company. Lesser of two evils. Of course I would probably trust an insurance company more than the US government too.

  43. sunchief32 says:

    @drrictus:

    My take on this article is that:
    1) She had leukemia
    2) She had liver failure
    3) She was in a vegatative state.

    My argument wasn’t pro-insurance…it was anti-doing absolutely anything and everything to prolong someone’s death by a matter of weeks. I work in Pediatric Critical Care and can tell you first hand that it would be an ugly mess to give a critically ill leukemia patient a liver transplant. It would have been a miserable existence for this poor girl. She would have suffered.
    However, I agree that it shouldn’t be up to the insurance company. My argument is that it sounds like she should have never been offered transplant as an option.

  44. Dr.Ph0bius says:

    This might be radical thinking… but when lifeor death surgery is required, you get it done and worry about insurance and such after.

    All that aside, Im wondering if the fact that she was “in a vegetative state, battling leukemia” combined with a lung infection and needing a bone marrow transplant means that there is a little more to this story than we’re hearing.

    And not to sound cold, but just because your insurance says “Yes” to a transplant, isnt there still a waiting list (I honestly dont know)? If so, then the fact that she died so soon after the doctors said she needed the transplant would indicate she would have dies before a liver was available.

    But thats no consolation to the family… Im just curious. Hey, Im one of the uninsured masses of Americans…

  45. sunchief32 says:

    @selectman:

    If my daughter had terminal leukemia I would punch someone who suggested putting her through a liver transplant.

    I agree that the insurance companies shouldn’t decide, though.

  46. Murph1908 says:

    @Judes:
    I couldn’t find in the article how much the procedure would cost, but you’d be damn sure if it were my daughter, and the transplant would save her, I’d find some way to pay it off, if it took my whole life to do so.

  47. noquarter says:

    @Murph1908: You won’t be able to give every procedure to every patient. Somebody will need to decide if the 94 year old smoker gets the heart and lung transplant.

    Correct, and that somebody better be a medical professional, not an accountant.

  48. burgundyyears says:

    @Captaffy: So in other words, the transplants are rationed and someone makes the call about who’s going to die and who’s going to live? Someone has to decide about making the transplant available to certain people and not to others.

  49. missdona says:

    @Captaffy:

    At my office, we have choices of a couple of different Insurance companies, also, my husband is employed at a different firm and we can choose from his plans as well. [i]I[/i] make the choice of what plan is best for me and my family. I like the choices that I have in healthcare. Raising my taxes and turning my choices over to my friendly government officials is frightening to me.

    Our government has proven again and again that they can’t form an agency that is effective and efficient. Just ask the Katrina victims how well FEMA took care of their needs.

    That’s not to say it’s not in need of reform. It’s absurd how many uninsured and underinsured there are here.

  50. Dr.Ph0bius says:

    @sunchief32: Thats kind of what I was getting at in my post right after yours… and really, it seems wrong to give a healthy liver to a person who is going to die in a few weeks and keep someone whos life can be saved waiting.

    It almost sounds like the family didnt want to admit that their daughters life was ended and wanted to spend a little more time “with her” in the hospital room…

  51. JadedScientist says:

    Rationing and bean counters aside, how many of you have registered to be organ donors AND have informed your families about this decision? Part of this debate stems from a chronic shortage of available organs, so register and potentially have something positive come out of your outrage. http://www.organdonor.gov Speaking of leukemia, the same thing goes for registering to be a marrow donor–and you don’t even have to die to save a life with that one. http://www.marrow.org

  52. Red_Eye says:

    @dreamcatcher2: It’s not a very far fetched thought. I am going to say something a lot of people aren’t going to want to believe but its the truth.

    Insurance companies are in it for the money.

    Are you aware that after a patient codes in some ICU’s there is a peer review of how the code is handled that since it covered by law by employer employee confidentiality its not even admissible in court what is discussed including any screw ups that could cost someone their life?

    Are you aware that after someone sustains a significant injury that could affect their long term care that doctors and insurance companies discuss what the cost of continued care versus them being pulled off life support would be? Inclusive of the cost of being sued if someone finds them negligent?

    Its time to wake up folks, if you are in the hospital and are significantly injured through that hospitals negligence its very possible for them to cover up the damage and pressure your loved ones to pull life support because in the long run it would be cheaper for them and the insurance to pay you for a lawsuit than to pay sustained care for a vegetable they create.

  53. drrictus says:

    @Red_Eye: Insurance companies like money? Is water still wet?

  54. missdona says:

    @jadedscientist:

    Me!

    My uncle had a lung transplant a couple of years back and we really saw how the whole process is so stressful and crazy.

    I think you have to have a very personal crisis with Organ Donation to really understand the whole thing.

  55. Murph1908 says:

    @noquarter:
    I agree.

    But your comment also suggests that the insurance company does not have medical professionals involved in these decisions.

    The girl had a terminal illness (leukemia)that was not going to be cured by the transplant.

    Government, insurance, or somebody will always need to make this decision. Does the benefit justify the cost? Sadly, only someone separated from the emotion of the situation will be able to make these decisions. This decision is made every day, and the ‘cost’ is not always monetary.

  56. mattpr says:

    @whoneedslight:

    You’re right that insurance companies shouldn’t be making life or death decision. However, they don’t. Doctors do. Doctors don’t need permission from insurance companies to do these things in life or death situations. People here can’t seem to grasp this.

    A transplantation of this magnitude would be a radically experimental, “last-ditch” effort with an incredibly high risk of complication, considering her previous bone-marrow transplant.

  57. just_paranoid says:

    she’s in a much better place now. sad story. i bet there are hundreds more like it you don’t hear about though.

  58. SexierThanJesus says:

    While I understand that the transplant might not have helped, in the end, this decision is not on the insurance company. If a doctor reccommends a transplant, it should not be up to a guy with a calculator to decide if she gets it. Insurance companies are not doctors, and I’m sick of having them tell us what procedures/medication we do or don’t need.

    With that being said, I wonder how long it’ll take in this thread for someone to blame her for “not taking care of herself”.

  59. dreamcatcher2 says:

    @Red_Eye: It gets worse when you consider all of the multiply-drug-resistant strains running around hospitals. Being in a hospital for any length of time, with holes in your body, has a high risk of complications, thus a high risk of high costs, thus a high risk of not being covered.

  60. clevershark says:

    Why is it so hard to accept that an insurance company is just as much of a bureaucracy as any government department? Proponents of profit-based health care systems *always* ignore that aspect of the issue, and instead go blathering on about how they don’t want “government beancounters” to make decisions for them.

    I mean, you can delude yourself into thinking that you’re making the decisions in a profit-centric system. However unless you’re a multi-billionaire who can afford to pay $100k (or more) out of pocket that just isn’t the case.

    If anything a profit-based system is worse because the insurance company involved has a direct vested interest in denying you expensive treatments. When you’re talking about a single government provider insuring everyone any one individual getting expensive treatment only costs the insurer marginally more than if treatment were denied. It’s an economy of scale, and no one in the insurer’s office has an incentive to unilaterally decide not to pay.

  61. SexierThanJesus says:

    @jadedscientist: Excellent point. I’m a registered donor myself. Not sure how much use my liver will be to anybody, but the rest of the package is all up for grabs.

  62. pastabatman says:

    Here’s the bottom line.

    Whether or not the liver should go to someone ‘survivable’ so as not to be a waste of a liver and/or money is not our decision. Not based on a group vote. Not based on what CIGNA thinks. It’s a decision (or SHOULD be) for the doctors involved in the case.

    simple.

    Theoretical arguments on the needs of the many outweigh the needs of the few is simply not the point. Cost is not the point. There really should be very little to discuss. If the doctors involved believe that a liver is the best course of action, then at the moment, at that time, we should accept their opinions. This is why we have doctors. They are trained and paid to make those assessments.

    CIGNA should not have a vote. Period.

    And furthermore, nobody here has any idea what they’re talking about as they were not there and in no way involved.

    It doesn’t matter what you read in the article, or what you think is best for the liver transplant system. The same goes for CIGNA.

    PB

  63. cnordholm says:

    The problem is that we have health care “insurance” when we should have constitutionally guaranteed “health care.” Make doctors and their ethics boards responsible and, with professionals in charge, everyone gets care lest their rights be denied. Oh, and this should go for education, too btw.

  64. AT203 says:

    More support for the proposition that giving all Americans health insurance is not the answer to our health care crisis. The profit-over-people health insurance industry is as big a contributor to the health care crisis as is the number of uninsured Americans.

  65. cnordholm says:

    @JUST_PARANOID Sorry to say, but she’s not in a better place. She’s dead and it’s an outrage. She will never experience many of the things that a human should because a corporation denied her the coverage she had paid for. Regardless of the specifics around this particular case, this will continue to happen until people get fed up with the system’s implementation and demand change of these companies or their abolishment.

  66. burgundyyears says:

    @clevershark: No, my point is that there will always be some bean counter making the decision. Pretending that it would be somehow better with an all-government system is just not realistic.

    @cnordholm: Health care cannot be made a right. Not now. Not ever. It is a commodity, a service, and is not available in unlimited quantities. Not even if you spent every last dime of the GDP on it.

  67. DrGirlfriend says:

    The underlying problem is that, currently, your healthcare is not determined by your doctors, it’s determined by your insurance company. And many hospitals will not treat you for a pre-scheduled procedure unless they either have been told by your insurance that it’s ok, or the patient coughs up cash up front. It’s a parasitic system caught in a terrible vicious cycle.

    In the end, insurance companies are a business. They will approach health care as a business, and businesses rarely do the right thing, especially if doing the right thing costs them money.

    @mattpr: A doctor can agree to waive his fee for a transplant. The hospital, however likely will not. So unless the doctor can transplant a liver in his office, his willingness to not require insurance or payment up front doesn’t mean much.

    Everything is profit driven. But the frustrating part is that, how could we expect it to be any different? Everything costs money. Hospitals need money to be able to stay open. Doctors need to make a living. Insurance companies need to be able to pay claims. Universal health insurance is not the answer, necessarily, because right now sate-run programs are even more restrictive due to their limited budgets. (Hey, Medicaid patient, learn to live with that hernia, because Medicaid won’t pay for you to get it removed!) Situations like these are the ones that make me very, very pessimistic about our ability as a country to improve our healthcare situation – the entire system, every last bit of it, is broken, because every last bit of it depends on money.

  68. Wormfather says:

    @AstroPig7: We’re getting awfully close to the day the insurance companies deny care for the birth of a baby, because after all, the mother and child will eventually die one way or another. Sickning.

  69. cef21 says:

    But, what if the insurance company was right? Their claim, boiled down, was “You want a liver transplant, but the data shows it won’t help you. So, we’re not paying.” What if the new liver really wouldn’t have helped? (I have no way to know, one way or the other.) Should the insurance company automatically say yes when a patient’s doctor asks?

    Also, note that going to a single-payer solution won’t solve this particular problem. Single-payer doesn’t mean “You get all the healthcare you want, when you want it.” It just changes the people who decide whether or not she gets the liver.

  70. clevershark says:

    @cef21: “What if the new liver really wouldn’t have helped?”

    That’s a call for a doctor to make, not an accountant who’s been told that he’ll take home a bigger paycheck if he says “no”.

  71. burgundyyears says:

    @Wormfather: Ladies and gentlemen, we have hyperbole!

  72. DrGirlfriend says:

    @cef21: This isn’t too far from how people qualify to even get on a transplant list. If the transplant won’t significantly help you, that organ is better used on a person who can be helped by it. Sometimes making these kinds of decisions isn’t pretty, and sometimes it’s not just insurance companies who have to make them – it’s just that their motives include money.

  73. FredTheGreat says:

    We can only hope that the people who made this decision at Cigna have children who will end up in this same situation and the company won’t cover their operations. Or better yet it happens to the Cigna people themselves, no need to punish their kids.

  74. youbastid says:

    @burgundyyears: No, jackass, there won’t always be a bean counter making a decision, as long as the President of the country and his cronies isn’t trying to run the government as if it were a business; that is, always trying make a profit. Many governmental organizations were started with the knowledge that they would be operating at a loss, and guess what? They did pretty well. The school system isn’t exactly making a profit, and it was doing great until the massive budget cuts of the last 20 or so years. Oh yeah those firemen and police officers aren’t exactly raking in the dough for the country either.

  75. psyop63b says:

    We are at a point where unbridled corporate greed in America is literally killing us.

  76. just_paranoid says:

    @cnordholm: dude wtf mate? why are you trying to jump on me for believing in god and that she’s in heaven. don’t be an a-hole. your rudeness is most certainly not going to bring her back. god needed her, and now she is with him.

    personally i’m not for doctors who play god. nor am i for keeping people alive. i believe in natural selection, survival of the fittest. her genetics are the most likely reason she was sick in the first place.

  77. levenhopper says:

    @Falconfire: They might not have been sure if it would have helped with her specific condition.

  78. banmojo says:

    I apologize that this will sound arrogant, but this case deals with details that lay people know very little about, and therefore cannot understand the complexities involved. Many of you are fast to jump to (likely) erroneous conclusions, THINKING you understand what’s really going on here. IF she hadn’t been in a coma, IF she hadn’t gotten the bone marrow transplant, IF she hadn’t been in a condition which made a liver transplant highly unlikely to be successful, she WOULD have gotten the liver transplant, and her insurance would have paid for it. You think she had a 2% chance of survival? Believe me, in that case she probably would have gotten the chance, especially given her young age (yes, they DO take that into account, as they should).

    Enough on this already – most of you are not qualified to be making intelligent logical conclusions from this case, and that’s just a fact, NOT me being arrogant.

    On another issue, this underlying fact is why politicians and lay people are having such a difficult time figuring out how to improve the health care system and its insurance system; this is why most law suits brought against MDs are frivolous, and even being frivolous stand a chance of being successful, because juries will NEVER understand what’s really at the root of the case, and it turns into a f$#@ing popularity contest.

    Our health care system DOES need major overhaul, but do NOT even think for an instant that Hillary or any other ‘politician’ (read: ‘practiced liar’) will have a viable solution. The answer is available, but those who are QUALIFIED to provide the answer are not the ones given the priviledge to provide said answer, and who’s fault is that in a democracy?

    “We care a lot” – about what, I don’t know. RIP Rodney Dangerfield, you made us laugh when all around us was trouble and uncertainty.

  79. Bladefist says:

    This is truly sad. This is not an example of why we should go to GOV health care. But, we do need to be more aggressive about making laws on the private sector. IMO insurance should be more cut and dry. Too much fine print these days.

  80. clevershark says:

    Well, I’m not in the least bit uncomfortable with the naysayers affirming their belief in private health care.

    However, I’m quite happy with the fact that I know I will not have to declare bankruptcy in the event that some uninsured drunken jackass gets in his car and hits me with it. If you’re a US resident you simply cannot say the same with confidence, unless you have several million dollars stashed away already for such an eventuality.

    You can sue the guy? Good for you, but if he’s going around driving without insurance (or regard for the law) chances are he’s not been putting away an awful lot of money to pay for the judgement in your favor.

  81. just_paranoid says:

    the planet is overpopulated as it is, partially the reason pollution is as bad as it is because we have become parasites to the planet earth, and as our population increases, so will the deadly pollutants, and toxins, sickness and disease. it is better that people die. death is sad, but inevitable, and some will live longer than others. but you know what they say, “only the good die young”.

  82. burgundyyears says:

    @youbastid: Bean counting, in one form or another, always exist in making decisions to grant health care or deny it (or perhaps delay it or put you on a waiting list, another form of rationing), even in systems where profit (EEEEEVIL!) is not really present (it is replaced with things like cost containment.)

    I don’t know what the rest of your post has to do with anything (even governmental institutions have to operate within a budget…sure, primarily funded with taxes but that doesn’t mean they operate at a loss.) If everyone got the $1 million treatments with the .1% probability of success, well, you would long have run out of resources, let alone any concern you have for profit or even treading water.

    And a very Merry Christmas to you and yours too.

  83. humphrmi says:

    @pegr: As posters to this article, it is not inappropriate to suggest that. It also would not have been inappropriate for Cigna to “suggest” that as well. Your suggestion here does not put a person’s life in danger if it’s wrong. You don’t make life and death decisions about a patient; doctors do. They go to college for a long time to learn how.

    The problem is when the insurance companies make a medical decisions, and require “evidence” like in a court of law in order to allow you to get treated.

    Regardless of the BS debate about universal health care, this is a huge problem with managed care.

  84. aka Cat says:

    I’m missing something here. Was there a lot more information in those articles than what I read? (I can’t view streaming video at work.)

    Near as I can tell, we don’t know if the bone marrow transplant cured her leukemia. But surely the Drs must have thought that it did, or that there was a very good chance that it would, if they recommended she get a liver transplant?

  85. just_paranoid says:

    “it is better that people die”

    to clarify for those who will take this out of context, it is better than keeping deathly ill people alive. of course, this is MY personal opinion, and i don’t expect other to be able to wrap their brain around the concept of overpopulation or natural selection and agree with me.

  86. youbastid says:

    @burgundyyears: Sure it always exists. But ask someone in the UK how much they’ve had to deal with bean counters in getting a much needed surgery. If things are handled (and handled properly) by the government, the bottom line is not an issue. Since we seem to have a bottomless pit of tax funds to pay for this war, surely we can dip into it for our own citizens.

    I’m not saying that the government should just take over and force its healthcare system on everyone. But who has a solid point arguing against a basic level of protection for every American citizen, with the option of purchasing your own complimentary policy from a private company?

  87. LiC says:

    Why did they wait to see if the insurance would cover it? Why didn’t the hospital just do the transplant?

  88. cef21 says:

    @clevershark: In general, though, this sort of decision is made by medically trained people at the insurance company, not accountants. And, recognize that if they never said no, medical insurance would be far more expensive than it is.

    Part of the solution is to make health insurance deductible when you buy it yourself. This would put insurers in the position of having to please patients by providing better services instead of pleasing their employers by sending goodie-baskets and being ISO 9001 certified.

  89. DrGirlfriend says:

    @youbastid: I think comparisons to the UK model, in this case, would have to be done only if we can get some info on how these particular kinds of cases are handled there. We hear a lot about being able to see your GP and get your meds easily, which is great. But how does their system handle cases such as Natalee’s?

    @LiC: Probably because a transplant is considered a “scheduled” procedure (verus one that occurs during an ER admission, for example). They knew beforehand that they wanted to do a transplant, and when you know beforehand, then hospitals always was insurance to be in place, or else deposits to be paid. I work at a hospital, with insurance. Transplants are wildly expensive, and not every hospital is accredited to do them – which means that a few facilities will be bearing the brunt of these patients. The facility will want some sort of assurance that they will get some money back. (disclaimer: This comment is meant to be explanatory and any attempts by anyone to try to bait me into a moral discussion about whether or not this is “right” will be ignored.)

  90. deadlizard says:

    I think we’re missing the picture here. Ask yourselves this
    question: If you get sick, are you sure your insurance company is not
    going to try to avoid paying for your care?

    Isn’t insurance supposed to be protection in case something goes wrong? Do you feel protected?

  91. burgundyyears says:

    @youbastid: Perhaps you and I aren’t using the same definition for bean counter. I would use the term for virtually anybody beyond the immediate treating doctor who’s making a decision about who can or cannot receive certain types care, or who must wait. I’m probably being a little too loose with the word. But such bean counting takes place everywhere: [news.bbc.co.uk]

    I’m already paying for a basic level of protection for a lot of Americans in addition to my own insurance (see: paycheck deduction for Medicare.) Same thing for retirement too (see: paycheck deduction for Social Security.)

  92. MaliBoo Radley says:

    @youbastid:

    I lived in England. My hubsand is England .. therefore half mf family lives on the NHS. Not a single one of them has ever gone without a medicine, treatment, surgical procedure etc. All of them get the treatment that their doctor says they need. Yes, if the condition is not life threatening you may have to queue for a procedure, but the procedure will be done. It’ far better than having to go without.

    Personally, I had better care with English doctors and hospitals than I ever had in the US. That might be because they professionals go into the job because the want to help people, not because they want to make loads of money. It’s just not about the bottom line.

  93. MaliBoo Radley says:

    Aarggh .. Meant to say my husband is English … Where oh were is the edit button?

  94. superborty says:

    @YOUBASTID: Ask the Canadians and the Brits how long they have to wait to see their doctors! Ask them how well educated their doctors are. Ask them why they don’t get some of the newest medical technology. Ask them why we are able to get more types of medicine than them. Ask them why they frequently head to our country for healthcare. Ask them why anybody who can pays for private healthcare….

    Not sure why you keep bringing up the war, btw..?? Maybe because our healthcare costs would be much lower if we allowed the terrorists to come over here and kill off a bunch of Americans? But wait, I’m sure they are just mad because we have a base in Saudi Arabia, right…………… Please stop being so naive. Understand the enemy.

  95. youbastid says:

    @radleyas: And if I’m correct, you also can choose to buy supplemental private care, right? NHS isn’t the only option? Or is it?

  96. youbastid says:

    @superborty: Read the above comment from someone on England’s NHS. Then stop parroting Fox News talking points, form your own opinion based on factual research, and come back when you’re ready to talk.

  97. superborty says:

    @radleyas: I also lived in the UK and the NHS was nothing but a nightmare any time I had to deal with the system.

  98. burgundyyears says:

    @radleyas: But I imagine none of them has needed a transplant either. Waiting lists are more or less a death sentence in such cases.

    And I don’t really buy the second paragraph. It sounds like an excuse or justification I hear bandied about for paying people subpar wages for doing a job. And besides, if you want to make the big bucks in the US, you become a lawyer, not a doctor.

  99. DrGirlfriend says:

    There is *always* a bottom line. If there weren’t, it would be cost-prohibitve to provide healthcare. Anywhere.

  100. Amelie says:

    I’m totally awestruck by the number of medical experts we have on this site. And the fact they have enough information about this case, is truly remarkable. Not only can I go to the consumerist to save money and screw it to the man, I can get free medical advice.

  101. youbastid says:

    I have asked both Canadians and Brits. And while we’re at it, don’t you ask the Canucks why there are buses filled with elderly Americans heading up to Canada for the drugs that apparently Canadians don’t have access to?

  102. SexierThanJesus says:

    @superborty: Is Free Republic down or something?

  103. superborty says:

    @youbastid: Oh no, another liberal evil keyword: Foxnews! Next will be Halliburton, Cheney, or religious-right. I have lived in both Europe and the US. My factual research is my own experience and my knowledge of the effect of free markets. Likely more than you bring to the table.

  104. superborty says:

    @zouxou: One-stop shopping….

  105. vastrightwing says:

    Make insurance companies and their officers responsible for negligent homicide. Let the courts decide who’s responsible. This might make insurance companies react a little more humane. Then again, maybe not.

  106. youbastid says:

    @superborty: It sucks that you had a nightmare situation with them, but with any service, not everyone’s going to be happy. It’s like Verizon Wireless – it works well but some people still get screwed. Unlike our current health care system, which follows the Comcast model better.

  107. Amelie says:

    I guess it’s always too much to ask that people search for additional information, before they make their knee-jerk assumptions:

    “Nataline was diagnosed with leukemia at age 14, and after two years of treatment the cancer went into remission, Hilda said. But this summer it came back.

    When doctors said Nataline could use a bone-marrow transplant, the Sarkisyans discovered that her only sibling, Bedig, 21, was a match, and he donated his bone marrow the day before Thanksgiving.

    But Nataline developed a complication from the bone-marrow transplant and, because her liver was failing, doctors recommended a transplant, according to an appeal letter sent to CIGNA earlier this month.

    But doctors said in the letter that CIGNA denied the transplant, saying Nataline’s plan does not cover “experimental, investigational and unproven services.”
    [www.dailynews.com]

  108. MaliBoo Radley says:

    @youbastid:

    Correct, there are plently of low cost supplemental insurance programmes.

  109. youbastid says:

    @superborty: Nope, I was just making a point that Fox News is the number one reason anyone still thinks that we’re in Iraq because we’re “keepin’ the terrorists over there, not here.” Nothing to do with liberal keywords.

    And yep, I’ve lived in both places as well. Never had to deal with the health care systems as I’m a healthy lad, but I certainly knew people who did.

  110. MaliBoo Radley says:

    @burgundyyears:

    Well, I’m not sure what to tell you. I’ve dealt with doctors for years in the US. I’m 29, I was born and raised here. I’ve had surgeries here. The quality of the medicine itself has always been high, but the human element has always been missing.

    This obviously anecdotal, as it is only my experience.

  111. deadlizard says:

    @zouxou: You’re right. Maybe doctors should base their decisions on the opinions by the posters here.

  112. HawkWolf says:

    So if CIGNA doesn’t cover “experimental, investigational and unproven services.” …..

    Who does?

    Do you just not do them? Do you wait for a University to telemarket its alumni until you have enough magical non-profit money to pay for it?

  113. noquarter says:

    @zouxou: I’m totally awestruck by the number of medical experts we have on this site.

    Agreed. There’s probably as much expert medical advice on this forum about this particular person’s case as there is over at CIGNA though. And that, in my opinion, is the real problem with the whole situation.

  114. HOP says:

    they oughta get the ceos of that company and string ‘em up…..low life blood sucking creeps…..they try to wiggle outta stuff just like state farm after katrina…..

  115. HOP says:

    hi

  116. EricaKane says:

    I feel bad for this woman and her family. Objectively, I just have some serious reservations about a liver transplant here. The woman had leukemia (and this was not a new case, it came out remission, which almost always is fatal), she developed some type of infection from a bone marrow transplant and then her liver failed.

    Obviously I don’t all the facts nor am I doctor, but looking at the timeline, it sure seems like a liver transplant would do nothing for this poor girl.

  117. teapartys_over says:

    @superborty: Any Canadian or Brit I’ve ever known loves their system, and would NEVER willingly switch to ours. In our country and in theirs, you can always find the extreme cases when a person was put on a waiting list or their insurance didn’t cover something. Overall, which system has more healthy people who are happy with the level of service they’re getting? I know so many people here in the US – doctors included – who hate our system and feel it’s broken. I just would be interested in an overall survey of Canadians and English – not just extreme cases which anyone can pull out – to see if they would prefer to abandon their system for ours. My guess is the answer would be no by a large margin.

  118. superborty says:

    @ Youbastid

    Don’t get me wrong. I despise insurance companies as much if not more than the others. Problem is the collusion in the industry. That’s what should be tackled. More problems: the frivolous lawsuits that doctors face. Lots of good docs are forced to move or close shop. Also, the good docs are leaving the insurance contracts and all their nonsense. All the insurance companies seem to be doing to me is raise their ST profits. They seemingly don’t understand their actions are turning the country to the ultimate evil: Hillarycare. Maybe that is what you desire, but I can think of better things than Nancy Pelosi deciding whether or not I qualify to meet with a certain doctor.

  119. drrictus says:

    @deadlizard: Waitasec….

    not ALL of these posters are doctors and medical experts??? How can you tell from their comments?

  120. MCShortbus says:

    OK, put aside the Insurance company for a second. I say screw the doctors. What happened to the hypocratic oath!? Save the girl’s life and then deal with the consequences. Don’t let someone die to save your own sorry ass/the hospital’s bottom line.

  121. selectman says:
  122. superborty says:

    @mcshortbus: Doctors have the ethics of lawyers. About the same amount of charm too.

  123. youbastid says:

    @superborty: Oooo, conservative evil keyword: HillaryCare! Next will be something about “San Francisco Liberal” Nancy Pelos-oh wait, beat me to the punch there.

    Why on earth do you think that basic protection for all US Citizens means Nancy Pelosi deciding whether or not you qualify to meet with a certain doctor? As it is right now, someone 3,000 miles away who has never seen you and knows nothing about you is deciding that. In all honesty, if I had to choose between the two, I’d take Pelosi.

    I find it both hilarious and outrageously hypocritical that the people in power who villainize “HillaryCare” happen to be the ones that are benefiting from a government run insurance program. Dick Cheney would most likely be dead right now if it wasn’t for the evil government and their comprehensive insurance.

  124. MCShortbus says:

    @superborty: Too true. I hope there is a special place in hell for Doctors and certain members of insurance companies (and beancounters) who do such horrible things.

  125. youbastid says:

    @superborty: Also, ask any doctor what he’s more afraid of: frivolous lawsuits or dealing with insurance companies. The frivolous lawsuits that are truly frivolous happen much less often than it would seem.

  126. BigNutty says:

    Simple Solution:

    My daughter needs transplant, insurance says no at the beginning, I bring my gun to hospital and force doctors to perform operation anyway, I go to jail, my daughter possibly lives.

    Moral of story: Don’t f**k with my kid’s lives.

  127. Indecision says:

    @BigNutty: “My daughter needs transplant, insurance says no at the beginning, I bring my gun to hospital and force doctors to perform operation anyway…”

    Wow, you’re quite possibly the biggest asshole in this thread. Let me clue you in to the correct response:

    My daughter needs a transplant, insurance says no, I politely tell the doctors “I realize insurance won’t cover the operation, please go ahead and do it anyway,” and I either battle the insurance company later or figure out how to pay for it.

    I also wonder why the people in the linked-to article here didn’t do that.

  128. youbastid says:

    @Indecision: Because they usually don’t perform it anyway if you don’t have any way to pay for it.

  129. Amelie says:

    @EricaKane: Not only are you not a doctor, but real doctors felt the transplant would work. Smart people talk about what they know, but why should that stop you or any number of people on this from voicing their ignorance.

  130. TWSS says:

    I wonder what Shannon Brownlee would make of this case. [www.nytimes.com]

  131. missdona says:

    @youbastid: True story.
    My mother had problems having her multiple hip replacement surgeries covered. The surgeon was willing to waive his fee to do the surgery; the hospital refused to donate an operating room and staff.

    They eventually worked it out and had it covered, but if they wouldn’t my parents would probably still be paying the hospital 20++ years later.

  132. bohemian says:

    Doctors are not going to attempt a liver transplant if it has a really low chance of success. Insurance companies don’t even look at the chance of survival.

    They do this crap to cancer patients all the time. Delay payment and other things if they think they might be on deaths door anyway.

    If you think insurance companies employ medical experts to make these decisions your fooling yourself. Most of these people don’t even have medical training.

    I predict that some day a doctor will snap after an insurance company pulls these games and causes a patient to die that would have otherwise lived.

  133. Amelie says:

    Oh and the California Nurses Association – better know as “not-as-smart-as-consumerist commentators” – felt the girl’s situation was worthy a demonstration:

    Nataline, recently treated at UCLA Medical Center with a bone marrow transplant for a recurring leukemia, developed a rare complication from the chemotherapy and transplant causing many of her organs, including her liver and kidneys to shut down. She is now in critical condition in the intensive care unit and multiple doctors have told the family that her only hope of survival is a liver transplant. Medically speaking, her doctors say that she is ready for the transplant. They also believe that her other organs will recover on their own if the liver is transplanted. CIGNA has ignored this medical decision and calls the transplant “experimental” as justification for denying the treatment.

    [www.calnurses.org]

  134. superborty says:

    @youbastid: I don’t think your boy Cheney would be dead now if it weren’t for government insurance!!! He did quite well in his professional career.

    You also don’t seem like you have thought about Hillarycare (nationalized healthcare) in too much detail. Many threads have had the same message. AT SOME POINT, it comes down to some bureaucrat making a decision about your healthcare. The unfortunate truth was written by ZouXou (if I remember right) when he said that the politicians would be in charge of settting the whole thing up. You better believe, the people in the know who likely have some reasonable solutions are not going to be involved. As was put earlier as well, look at the government control of airport security. The biggest joke in the world. Look at the government control of almost anything (DMV, schools, etc…) and you will find an unsatisfactory result.

    Massive change is needed. Insurance companies need to be put in line in one way or another. The system clearly isn’t working but that doesn’t mean we switch to communism.

  135. EricaKane says:

    @zouxou: Yea well unless you know the facts and saw the actual letter the doctors sent to the insurance company, you shouldn’t be talking either.

  136. Sudonum says:

    Those debating the relative benefits of the US vs Canadian systems, this was in my mailbox this morning.
    [www.factcheck.org]

  137. consumerd says:

    Sounds like another case needed for universal healthcare. You can’t waffle if you are responsible and the only one. The rest of the civilized nations get it right (france, canada, britian), only when we stand up and demand it from our representatives will we “get it right”

    Till then… “sucks to be her”

  138. Amelie says:

    @EricaKane: Considering I’m not offering medical opinions, you can’t compare it to your “I don’t know jack opinions.” And while your at it, care to prove that the remission of her leukemia is most certainly a death sentence, like you previously said.”“and this was not a new case, it came out remission, which almost always is fatal”

  139. youbastid says:

    @superborty: The government control of the Fire Department, the Police Departments and the schools always goes fine, until some free market Republican gets into office, says “The government doesn’t do anything right,” and proceeds to make sure his point is proven by slashing the budgets of all of these organizations. The government can run pretty damn well when someone that believes in it is in charge. The DMV sucks but no one goes there often enough that a big deal needs to be made.

    And re: “my boy” Cheney, read this:
    [www.cbsnews.com]

    I know it’s referring to an ad, but the point it makes better fleshes out what I was saying.

  140. youbastid says:

    @youbastid: Also, look what happens when we give something up to private firms with no accountability *cough* Blackwater *cough*…Airport security is a joke, but again, it’s underfunded.

  141. EricaKane says:

    @zouxou: Start googling, here is a top result after leukemia relapse fatality rate
    [jco.ascopubs.org]

  142. EricaKane says:

    @zouxou: or here:
    [www.acor.org]

    I’m not giving medical advice, rather medical facts. The fact is that leukemia, after relapse, is a very hard thing to treat and the prognosis is not very good…

  143. parnote says:

    HOLY SHIT! I’m a medical professional, and this kind of crap IS A DISGRACE! Insurance companies have WAY WAY WAY too much say in the care that we, as health care consumers, receive.

    And is it any wonder why Universal Health Care is on everyone’s mind??? Stupidity, such as this, just makes the UHC case stronger and stronger, case by case!

    I say BRING ON UHC! It couldn’t possibly be any worse than the shoddy, patched-together health care system we are now involuntarily tied to!

    AAARRRRRGGGGGGGHHHHHHHHHH!!!!!!!!!

  144. SacraBos says:

    @sunchief32: From the article, due to pain/etc she was induced into a coma while they were fighting this. If she had fallen into a coma due to leukemia, it’s unlikely the doctors/nurses would have pressured to have the procedure, since it’s likely she wouldn’t have survived it.

  145. CurbRunner says:

    Does anyone out there have the email and or home addresses of CIGNA executives and board members?

    I think it’s time they feel and abundance of direct responses related to their moral and criminal lack of action that caused the death of this young girl.

  146. EricaKane says:

    The California Nurses association said that the family was told it could put a $75,000 down payment on the procedure and go through with it. The family said they could not afford it.

    I don’t know, $75,000 isn’t an astronomical figure…I’m sure most people could scrounge around for that kind of money, refinance the house, borrow money, cash out the retirement. I know I would do it for my daughter and then I would sue the insurance agency. In fact, I would get a lawyer to sue the insurance company the day of rejection, get some type of injunction and then move forward.

    I’m just saying there were ways for this family to push this transplant forward without relying on the insurance agency to reverse its course. Go ahead stone me if you want, but if it was my daughter sitting there, you bet I would do it.

  147. noquarter says:

    @EricaKane: You’re right, it probably didn’t occur to them to pay money to save their daughter’s life.

  148. youbastid says:

    @EricaKane: True. If I were to guess, they were probably in the process of scrounging around for that kind of money…They didn’t have much time, and it takes time to get loans, refi, etc. And God help them if they didn’t have good credit.

    I do know that for a lot of people, $75,000 is an astronomical figure. It also costs a lot of money to get a lawyer to sue a giant insurance company to get an injunction. I’m just gonna go ahead and give them the benefit of the doubt.

  149. EricaKane says:

    well i’m not sure how much money it would really cost to get a lawyer to get a emergency temporary restraining order here…we’re not talking about a very complicated proceess…you file a complaint, then at the same time, you file a TRO. you go see the judge the next day (or the same day possibly) on an emergency basis and the judge could issue some kind of ruling forcing the insurance company to at least pay the down payment and then try to recover from the family if the case ultimately is found in the company’s behalf.

  150. Amelie says:

    @EricaKane: Maybe you should learn how to “google” before you start telling others they need to “start googling.” Your first reference was to a particular kind of leukemia “Relapse of Advanced Myeloid Malignancies,” and you second a generalized site on childhood leukemia, which did not support your contention about there not being a chance. It only stated: “Relapsed leukemia. Relapse, or recurrence of leukemia, can occur anytime during therapy or after completion of treatment. Generally, it is more difficult to cure a child after relapse of the leukemia; relapse during or soon after the completion of treatment is considered less favorable than relapse a year or several years after treatment. Treatment depends on the site of relapse, whether it is in the bone marrow, central nervous system, testes, or other locations. Aggressive chemotherapy and radiation treatment, often followed bone marrow transplantation, are used to treat relapse of childhood leukemia.

    If she “did” have childhood leukemia, a relapse after several years offered a better prognosis.

  151. SacraBos says:

    This situation is also why I get so upset at all these people that cry about people not having health insurance. The issue is health CARE, and whether it’s rationed by private health insurance or government insurance – health insurance will suck. Health Insurnance (CIGNA and all of them) are not in the business of making you health or dead. That’s your doctors job.

    The health insurance’s job is to make more money from us (as a collective) than they pay the doctors. If we get Hillary-Care (or whatever), the same game is true. They will simply have to make more money from us (via taxes) than they pay doctors.

    It used to be getting a second opinion was considered a good idea, now people just try to find a doctor in their “plan” and take what they get. My wife changed doctors to one in her “plan”, and he sucked. Ended up going out-of-plan to the prior one, since he actually knew what he was doing.

    Yes, I’m a little outraged that CIGNA didn’t pay (they should have, since that’s what they were paid to do, let their actuaries figure it out). This does little to improve my already sour opinion of the whole health insurance industry.

  152. ceejeemcbeegee is not here says:

    I’m glad y’all posted this.

    The more I watch my fathers’ HMO, PPO, and Medicare fight over who’s paying for his necessary medical procedures, the more I’m convinced I need to become a millionaire and pay cash for any medical attention I need. Do hospitals take Amex?

  153. ceejeemcbeegee is not here says:

    @EricaKane: You are right, most parents would.

    But maybe these folks were already over-extended because of their daughters’ previous medical bills? Maybe do to that, they have horrible credit and can’t get loans or re-fi? Maybe they have little equity or are upside-down on their home and can’t get a HELOC? Maybe they dont’ even won a home? They do live in the Los Angeles area… the most overvalued property market west of the Mississippi.

    The point is we don’t know their financial situation, so it’s pointless to speculate on why they waited on the insurance to pay. I’m going to give them the benefit of the doubt here.

  154. prateeko says:

    The decision should not have been made by a bunch of jackasses with calculators, but rather doctors and other informed individuals who can actually say (not just provide numbers) whether or not the transplant would be beneficial.

  155. stanfrombrooklyn says:

    I currently have a big red boil on my ass. Could the many doctors on the Consumerist board please diagnose this for me?

  156. DrGirlfriend says:

    @stanfrombrooklyn: it’s either a pimple or the bubonic plague.

  157. JustAGuy2 says:

    Let me ask one question here:

    Who should decide whether she gets the transplant or not? Some are arguing it should be the doctor’s call, period. Are the individual doctors the best equipped to decide about the allocation of resources? They’ve got the responsibility to their patients to do everything possible – it seems to me that conflicts with the need to, at times, NOT do everything possible.

    At the end of the day, health care (like any other service) needs to be rationed somehow. We can’t just give every possible treatment to every patient, regardless of the cost, benefit, or chance of success.

    Whoever’s paying (be it private insurance or the government, this isn’t a US vs. UK/Canada issue, it’s universal) needs to have some say in the services provided.

    Resources aren’t infinite, and they need to be allocated somehow, whether that’s by price (everybody pays cash, and the people who can afford it get whatever they want), by mandate (government says “x procedure is authorized, y is not, doesn’t matter how much you want to spend”), or by a combination (CIGNA says “we’re not paying for X because the upside is too small and the cost too great”).

  158. EricaKane says:

    @zouxou: Yeah those reports use words like poor and difficult, which is just a nice way of saying you’re screwed if leukemia comes back..but whatever.

  159. EricaKane says:

    And another thing, the California Nurses Association is an organization dedicated to preserving their members interests, not the interests of the general public and one should be very wary of their agenda here, IMHO.

  160. ceejeemcbeegee is not here says:

    @JustAGuy2: We can’t just give every possible treatment to every patient, regardless of the cost, benefit, or chance of success.

    So… screw saving a life if it’s too expensive or if it might not work? I’d hate for you to be my caregiver.

    @EricaKane: I don’t see how the nurses would have a hidden agenda here… unless it was to keep the girl alive so they’d have one more patient to care for.

  161. JustAGuy2 says:

    @ceejeemcbeegee:

    Yes, that’s exactly what I mean. Sorry, but it’s the truth. I know we don’t like to think of it in these terms, but there’s no way around it. You have to draw the line somewhere. We don’t have unlimited resources, and it doesn’t do anybody any good to pretend that we do.

    Think of it this way: what if there were an operation that cost $1 billion that had a 1% chance of extending the life of the patient for one day. Should everyone get that operation? If so, once we’ve done 2,000 of them, we’ll have consumed the Federal government’s entire annual budget, and extended the life of 20 people by a day each. Does that sound like money well spent?

  162. swalve says:

    @Murph1908: I agree- why didn’t her parents say “do the transplant, we’ll find a way to pay for it”. And then the girl gets the transplant and they go and find a way to pay for it.

  163. swalve says:

    @ceejeemcbeegee: The nurses DO have a “hidden” agenda. Keep the cost of medical care high, continue the “nursing shortage” and continue making $100,000 a year. Not bad for a profession that one only needs an associates degree to go into in some states.

  164. DrGirlfriend says:

    @swalve: Because hospitals require deposits for these kinds of procedures. They don’t just say “oh, I’m sure you’re good for it”.

  165. swalve says:

    @DrGirlfriend: Seems like it’s the hospital’s fault then. They were the people who had the power to do the transplant and didn’t, for the sake of money.

  166. cryrevolution says:

    I don’t understand why ANYBODY on this thread would side with the insurance company. If a licensed doctor thought a liver transplant would be successful, taking her age & the severity of her situation into account (because, ya know, doctors do that), and a liver became available for her, why the JEEBUS would the insurance company say otherwise? Since when did liver transplants become “experimental” when a doctor suggests it? The point is, the insurance company knew they were wrong. They tried to backtrack & it was too late. If they had ANY grounds to stand on, the ins. co. would have stood by their refusal. But they didn’t. And they reversed it. @EricaKane:And to whom is $75K not an “astronomical amount”? Are you kidding? The average middle class family doesn’t just have a $75K deposit on their hands. We have no idea what their financial situation is & I’m sure if they had that amount of money lying around somehow to save their daughter, they would have used it.

  167. cryrevolution says:

    @DrGirlfriend: Sadly, thats how it works. If anyone has seen John Q (sans the bringing a gun in & threatening hostages part), its the perfect example.

  168. swalve says:

    @cryrevolution: Doctors aren’t perfect. Sometimes, they might be outright corrupt. Being licensed doesn’t make them instantly qualified. Just means they passed a test and haven’t been caught screwing up too badly.

  169. Dvizzl says:

    I read another article about this case and it mentioned one important fact that they left out of all the others: the liver transplant had a 65% chance of success for a six-month survival rate No wonder the insurance didn’t want to pay for it. And to give this girl a liver that could have gone to someone who needed it so much more…well, I’m not sure this case is entirely as black and white as it’s being made to seem.

  170. Leohat says:

    *sniff*sniff*. What’s that I smell? I think I smells a lawsuit.

  171. bestuser says:

    ” BY BURGUNDYYEARS AT 10:05 AM

    I can’t wait until government bean counters make these care rationing decisions instead. All the bean counting with the added bonus of lawsuit immunity. “

    the government already does this, it’s called medicare. duh?

  172. burgundyyears says:

    @bestuser: Yeah, I just can’t wait until it’s universal, can’t you? If there’s one thing government does well, it’s that it protect its own when it comes to these sorts of things. I predict a government entity would not have reversed course on this one and denied it until the bitter end – they are that much less responsive to public pressure.

    Or maybe we’re just conditioned to government screwing up, so if they would whiff on these sorts of things, who would really even care?

  173. pastabatman says:

    @JustAGuy2:

    you’re making a couple of assumptions that make it hard to see your side.

    1. that anyone has ever had a 1 billion dollar treatment with a 1% survival rate. I understand your point (there is no such thing as a treatment that expensive) but you assume that EVERYTHING is done to save a life even if it has a 1% success rate. seems unlikely that any rational system would do this, infinite budget or not.

    2. You seem to know the mechanism for which a fantasy UHC in the USA would make decisions on treatment. You don’t know that. What we DO know is the way in which it’s decided now. By either a business, who’s primary self interest is profit OR by whether you actually have insurance at all OR if you can just pay for whatever you want.

    Just one thing to keep in mind, you’re social Darwinism sounds fair to you, I’m sure, from the big birds eye view you enjoy while not staring down the barrel of this statement:

    “The treatment is too expensive. We are letting you die now.”

  174. MommaJ says:

    Based on the meager details in the article, I don’t know how anyone can offer an opinion on the medical issues in this sad story. But here’s what I do know, based on personal experiencing with a comatose mother: 1)surgeons above all want to do surgery, and many will recommend it even when the chances of long-term success are minute, plus they have a financial stake in performing more surgery, as does the hospital; and 2)most families will grasp at any straw and often don’t even ask the surgeon whether the procedure is worthwhile because they don’t want to hear the answer. I already pay astronomical rates for private health insurance, and I want my insurer to properly evaluate the procedures it pays for. To say the insurance company should have no input is absurd. To say it should be the final arbiter is also wrong. Perhaps there should be an independent third party that can quickly adjudicate when these disputes arise.

  175. Rhyss says:

    To those debating the amount of money and resources (liver)that should be used or not used to possibly save a life – where do we draw the line. At what point is a x% chance of survival not “enough.” If the person in question is 80yrs or 12yrs old. This is a slippery slope. The mentally ill? The disabled? My child, not yours? 1984 anyone?

  176. KJones says:

    I @pegr:
    Your comment would be inappropriate if her life could have been saved. If there was time to save the girl’s life and the company denied coverage, leading to her death, then they are subhuman.

    CIGNA are whores for money. They didn’t care about Sarkisian’s death except for the office betting pool.

    @mwdavis:
    You’re right, “beancounter” is too polite. How about BONEcounter?

    Those bastards deal in death – and deal out death – for profit. In any other business, they would be held accountable. For example, some car manufacturers decide not to recall unsafe cars because it’s “cheaper” to pay settlements. When they do it, they face class action lawsuits.

    Maybe it’s time for the families of those murdered by insurance companies to collectively file suit against all them.

  177. swalve says:

    @Rhyss: It already happens. Nobody wants to discuss it, but it does.

  178. KJones says:

    @Sudonum:

    The Fraser Institute is NOT “libertarian”. It is far right wing, like the current Canadian government.

  179. KJones says:

    @JustAGuy2:

    You are suggesting that without insurance companies to “guide” them, doctors would friviolously do surgeries that have no hope of success. Which insurance company do you work for?

    Doctors have the knowledge to make those decisions, accountants and lawyers do not. If the patient has no hope, the doctors will make that decision and tell the patient, not the insurance company make the decision and NOT tell the patient, ie. “it’s under consideration”.

  180. watcher68 says:

    Medicine today is driven by evidence based medicine. If there isn’t any good evidence to drive the medical decision making process, then the decision is based on the art of medicine. Given that the doctors stated that there was a 65% chance of a 6 month survival (the other question was what was the 5 year survival under the same conditions), it seems that there might have been some documentation of such an event. If, however, the numbers did not support the procedure, then the insurance company might be justified to refuse the procedure. Doctors and hospitals can not override insurance companies and routinely give out medical care even in light of saving lives as the costs would shut down a hospital (just look at emergency rooms around this country). This is more of an issue since it involves a donated organ and aftercare for what would hopefully be years to come. There isn’t enough information from the media to gauge if CIGNA operated out of normal policy here or if their policy regarding transplant is wrong. Certainly, with the lawsuit pending, that will be brought out into the light. It will be interesting to see if a doctor or a group of doctors made the decision.

    I don’t know how it feels to have someone I love faced with such a situation (especially a child). For now, I wish the family God’s peace and comfort during this time of grief.

  181. GeekChicCanuck says:

    I don’t know if anyone will read this far – but I thought that I would post these comments from a transplant surgeon that is a colleague of my cousin (a pediatric oncologist):

    “That is a sad story that you sent. I can’t really comment on the specifics as I don’t have enough information but I can certainly answer your questions about how transplantation works in Canada. When someone dies, the family is approached by a specialist doctor who has not been treating the patient.

    If the family agrees to donate their loved one’s organs and/or tissues then the patient’s blood type, detailed antibody information and their height and weight are sent to the nearest regional organ donation centre. For organs that are time sensitive (livers must be transplanted within 24 hours but we prefer to not go past 15 hours out of body), the closest recipient that is highest on the list that matches the patient’s blood type, antibodies and body size is selected. It may interest you that the nearest recipient may be in the U.S. as we have an agreement to share organs with them if no Canadian is in a position to benefit.

    Your position on the list is based on how sick you are (you can be too sick), your blood type, how long you’ve been waiting and your height and weight (these last two are more important for kids and for some organs). This system was created by doctors and is run by doctors. No members of the government are involved.”

    I have his permission to post this here. I hope it helps someone.

  182. crypticgeek says:

    This is very sad. But what’s honestly even sadder is these stories happen EVERY DAY. The denial of life saving procedures is common place with HMOs. The denial of coverage for ANY REASON they can come up with is profit for them and misery for patients. In a modern and prosperous nation such as this, the idea that health care is a RIGHT and not a privilege should have been adopted by now.

    This is really a moral issue. How can anyone say that insurance companies profiting off the death and misery of patients is moral? How can you sleep at night knowing that? There are times when I honestly can’t. The conservative republicans scream about gay marriage and abortion, but say nothing about HMOs lining their pockets by denying care to those who need it. That’s because they get a cut of the profits donated to their re-election campaigns. They are bought and paid for by the insurance companies. I’m not a Christian man, but if I were I would have to say these people are some of the most evil and immoral people alive.

  183. CurbRunner says:

    @prateeko:

    It would appear that if accountants are making medical decisions that differ from what doctors recommend that they are practicing medicine without a license whether they accept the doctors’ recommendations or not.

    Practicing medicine without a license is both fraudulent and illegal.

  184. guevera says:

    @youbastid and @superborty: I have to give my $0.02 on the whole FOX news thing.

    I’m in the news biz, and the reason FOX is, indeed, evil is that the shot-callers there have made advancing the right-wing agenda a, if not the, major focus of the network.

    Say what you will about the other network and cable operations – and there’s a ton you can say – but the fact is they at least TRY to get it right.

    FNC doesn’t bother. That’s not the mission. I don’t begruge FOX its success as a BROADCASTER. But you can’t pretend it’s a NEWS operation.

  185. failurate says:

    Not a doctor, but I play one on the internet… Don’t really understand what a liver transplant will do for a leukemia patient?
    Is it possible that the doctors were just trying to wring a few more dimes out of a fatally ill girl and her insurance company?

    Having worked at an insurance company, the accountants don’t play doctor… they actually pay doctors as “third party” consultants to review questionable claims.
    It is really a system that is not designed with emergency medicine in mind.

    Very sad story here.

  186. helloall says:

    I’m a physician, and I’ve worked with the liver transplant service at UCLA. I can tell you that the people working there are among the most intelligent and experienced in the world. They completely understand the implications of proceeding with a liver transplant in every patient on who they operate. Although I do not know the patient’s story, all patient with end stage liver disease develop encephalopathy, where they enter a coma state, and this is often reversible following a liver transplant. If the team decided that it would be worthwhile to proceed with a liver transplant, she should have had one in a timely matter. It simply should not matter what the insurance accountants think.

  187. Mbilo says:

    Nationwide Customer Care: 1.800.CIGNA24 (1.800.244.6224)

    Make your voice heard. Give Cigna a call and express your disdain for this company.

    Their motto is: A Business of Caring.

  188. tailstoo says:

    While I can’t defend CIGNA for what their actions, there’s also something that has to be done about the cost of health care. My mother had Leukemia, and she for it for about 18 months. It used to cost her almost $10,000 a day to be in the hospital, and every test, procedure, and treatment was extra. She passed away in August, after more than 2.7 million dollars was spent. Lucky my dad had good insurance – where I work, the best plan covers 90% – I would still have had to pay $270k.

  189. CAgurlie says:

    I am a paralegal, I am not allowed to practice Law I can only assist in the process the attorney practices law. We are intensly careful about conflicts of interest. Law much less often is it life threatening. Once Medicine was only practiced by a doctor, not insurance carriers with the worst possible conflict of interest. Please Mr. Gerogoose push the criminal side of this if we pay for insurance to save our lives no one should have a right besides the patient to refuse medical treatment.

  190. JustAGuy2 says:

    @helloall:

    How can it not matter?

    Again, who decides what treatments/procedures patients get?

    Somewhere, there’s got to be somebody empowered to say “it’s just not worth it, we’re not paying for it.” Doctors aren’t well-positioned to do that, because they have an obligation to do everything possible for the patient.

    There has to be somebody who can say, as harsh as this sounds, “it’s not worth spending that much money, given the combination of benefit and likelihood of success.”

  191. burgundyyears says:

    [online.wsj.com]

    Lesson:
    Avoid rushes to judgment.

    Not that I expect anyone here to actually learn that.