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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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?
@superborty: Is Free Republic down or something?
@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.
@zouxou: One-stop shopping….
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.
@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.
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]
@youbastid:
Correct, there are plently of low cost supplemental insurance programmes.
@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.
@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.
@zouxou: You’re right. Maybe doctors should base their decisions on the opinions by the posters here.
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?
@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.
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…..
hi
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.
@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.
@ 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.
@deadlizard: Waitasec….
not ALL of these posters are doctors and medical experts??? How can you tell from their comments?
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.
@pastabatman: +1
@mcshortbus: Doctors have the ethics of lawyers. About the same amount of charm too.
@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.
@youbastid: Stop saying that we want nat. health care who would support a model that would keep Cheney alive.
@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.
@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.
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.
@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.
@Indecision: Because they usually don’t perform it anyway if you don’t have any way to pay for it.
@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.
I wonder what Shannon Brownlee would make of this case. [www.nytimes.com]
@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.
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.
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]
@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.
@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.
Those debating the relative benefits of the US vs Canadian systems, this was in my mailbox this morning.
[www.factcheck.org]
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”
@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”
@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.
@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.
@zouxou: Start googling, here is a top result after leukemia relapse fatality rate
[jco.ascopubs.org]
@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…
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!!!!!!!!!
@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.
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.
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.
@EricaKane: You’re right, it probably didn’t occur to them to pay money to save their daughter’s life.
@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.
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.
@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.