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.

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

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.

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?)

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.

And once again, cue the Lee Greenwood music....

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.

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

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.

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.

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

Pathetic.

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.

@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.

"Beancounters?" Much too nice a term.

@morganlh85: Robots don't sleep.

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.

But would the liver transplant have saved her life?

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.

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

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

"Get the chalk!"

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.

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

@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.

Yeah, universal health care! Let some bureaucrat decide!

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.

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).

@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.

@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!

@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.

@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.

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

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.

@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.

@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.

@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.

@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.

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.

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.

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.

@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.

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.

@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.

@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.

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...

@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.

@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.

@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.

@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.

@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.