California teen dies after insurer reverses transplant decision

[Kazan' Tiger 1]

You would think this is how it should be!

If the insurance company views the patient as terminal, they will not approve a transplant.

And I thought that the doctor and patient should get to make that decision rather than some profit oriented insurance bureaucrat.

[Chica Yeyé 41]

If the insurance company views the patient as terminal, they will not approve a transplant.

And I thought that the doctor and patient should get to make that decision rather than some profit oriented insurance bureaucrat.

Ditto. this is beyond sad - it's inhumane. Another form of cruel and unusual punishment, with a perverse twist.

[w¡n9Nµ7 §£@¥€r 123]

LOS ANGELES – The family of a 17-year-old leukemia patient has sued health insurance giant Cigna Corp. for her death in 2007 after the company initially refused to pay for a liver transplant.

The lawsuit filed last week in Los Angeles County Superior Court by the family's attorney, Mark Geragos, alleges breach of contract, unfair business practices and intentional infliction of emotional distress. The suit accuses Cigna of delaying and rejecting valid claims, which resulted in the wrongful death of Nataline Sarkisyan.

The Philadelphia-based insurer eventually approved the transplant after Sarkisyan's family held a rally outside Cigna's suburban Los Angeles office. Nataline, however, died hours after the approval was secured.

Chris Curran, a spokesman for Cigna, said the company empathizes with the family but feels the lawsuit is without merit. Curran said Cigna volunteered to pay for the procedure out of its own pocket and not the employer's.

"This decision was made despite the fact that Cigna had no obligation to do so and despite concluding, based on the information available, that the treatment would be unproven and ineffective and therefore experimental and not covered by the employer's benefit plan," Curran said, reading from a statement.

http://news.yahoo.com/s/ap/20081226/ap_on_...iver_transplant

[Danno 1,228]

Putting all the emotion aside, this is a simple case of paying an Insurance company for risk coverage. If her policy allowed for this type of coverage then Cigna will pay dearly in court.

If she was not covered, how can one fault Cigna or you or me for not paying?

It's so sad to hear about cases like this but those who work in this level of Healthcare know

we do not have unlimited organs or money to do "shot in the dark" operations. (if this was the case.)

This is exactly why Public-healthcare will cost through the roof!

Every time we have some tragic case like this, Politicians will play HERO by sponsoring Bills extending coverage to unlimited healthcare, no matter the cost, no matter the odds of success, no matter the situation.

90yrold coma patients will be getting hip replacements. (okay so that's stretching it a bit)

As an aside: I thought to get an Organ transplant, one was placed on a "highest-priority X likelyhood of success" type list

with ability to pay NOT Considered?

Someone who knows how this works please comment?

Edited December 27, 2008 by Danno

[Kajikit 65]

The article mentions she was vegetative - but still the idea that the insurance companies can or indeed should overrule a doctor's professional recommendation is rather unsetlling.

She was in a vegetative state because the insurance company had denied the family's claim to have the transplant. Then they waffled and came back, too late, and approved it. Had they approved it the first time around, when the girl was concious and still healthy enough to survive the surgery, she'd have probably lived a good long life.

Except for the fact that she still had leukemia! She wasn't an otherwise-healthy teenager who developed liver failure, she was already critically ill and the odds are that giving her a liver transplant would just be clutching at straws...