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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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.
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?
@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.
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.
I currently have a big red boil on my ass. Could the many doctors on the Consumerist board please diagnose this for me?
@stanfrombrooklyn: it’s either a pimple or the bubonic plague.
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”).
@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.
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.
@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.
@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?
@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.
@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.
@swalve: Because hospitals require deposits for these kinds of procedures. They don’t just say “oh, I’m sure you’re good for it”.
@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.
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.
@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.
@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.
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.
*sniff*sniff*. What’s that I smell? I think I smells a lawsuit.
” 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?
@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?
@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.”
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.
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?
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.
@Rhyss: It already happens. Nobody wants to discuss it, but it does.
@Sudonum:
The Fraser Institute is NOT “libertarian”. It is far right wing, like the current Canadian government.
@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”.
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.
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.
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.
@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.
@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.
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.
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.
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.
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.
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.
@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.”
[online.wsj.com]
Lesson:
Avoid rushes to judgment.
Not that I expect anyone here to actually learn that.