17- year-old girl needs liver transplant, CIGNA denies - page 4

by pickledpepperRN

17,409 Visits | 109 Comments

Life Denied: Nurses, Family of Sick Teen March on Health Insurance Company Thursday - 17- year-old girl needs liver transplant, CIGNA denies... The family and the nurses are urgently appealing to the public to call CIGNA at... Read More


  1. 3
    Sadly, without money the hospital would go bankrupt. I can't pass judgement on this particular case, but honestly the hospital would go under if they did not get reimbursed. I can relate because I wouldn't work as a bedside nurse if I weren't paid. Financial renumeration is my #1 reason I go to work.

    It's a sad case, but I don't see it as a black and white one.
    dria, SuesquatchRN, and Spidey's mom like this.
  2. 0
    This article indicates that Cigna initially approved the liver transplant surgery, but rescinded the approval when she began to experience complications that made it less likely that they surgery would be successful.

    The Sarkisyan family claims that CIGN first agreed to the liver transplant surgery and had secured a match weeks ago. After the teen, who was battling leukemia, received a bone marrow transplant from her brother, however, she suffered a lung infection, and the insurer backed away from what it felt had become too risky a procedure.

    http://abcnews.go.com/GMA/CancerPrev...4038257&page=1
  3. 1
    Ultimately the decision should have been her, her families and the doctors to make NOT the benefit denial specialists at Cigna. The insurers make money through denial of appropriate care.



    There actually was a Law and Order episode on TNT yesterday that discussed this very issue of insurers denial of care.

    In this case our flawed reimbursement system in all probability contributed to this girls death.

    Rationing by ability to pay kills patients:

    The U.S. Supreme Court recently established that rationing is fundamental to the way managed care conducts business. Rationing in U.S. health care is based on income: if you can afford care you get it, if you can’t, you don’t. A recent study by the prestigious Institute of Medicine found that 18,000 Americans die every year because they don’t have health insurance. That’s rationing. No other industrialized nation rations health care to the degree that the U.S. does.
    http://www.pnhp.org/facts/singlepaye...#canada_ration

    In this case she died as a result of underinsurance.
    Simplepleasures likes this.
  4. 3
    ABC got some important facts wrong.On December 11, 2007 UCLA had a matching liver and on that day Cigna denied to transplant as “experimental”. She developed pneumonia and had to be sedated AFTER the denial.
    Yesterday on December 20th I was there when Cigna approved the transplant.

    I don’t think anyone will ever know whether she would have survived if she had received the transplant. The denial guaranteed her death.

    Also ABC stated she lived in Glendale but did NOT. She lived in Northridge. The rally was at the Cigna office in Glendale.
    Cigna refused to pay for a 17-year-old leukemia patient's liver transplant until the family staged a protest Thursday, but Nataline Sarkisyan died shortly after the reversal.

    A grieving family is blaming an insurance company for the death Thursday of a 17-year-old leukemia patient, who died hours after the company reversed course and agreed to pay for her to receive a liver transplant….

    … "She had a 65% chance of survival if she had gotten the liver," Hilda Sarkisyan said from her home this morning.

    The Sarkisyans' insurer, Philadelphia-based Cigna HealthCare, denied the transplant earlier this month.

    Doctors at UCLA sent a letter Dec. 11 to Cigna emphasizing that Nataline was eligible for a transplant, Hilda Sarkisyan said. But Cigna refused to pay, citing a lack of medical evidence the procedure would help….

    … On Thursday, the family rallied supporters online and staged a protest at Cigna's Glendale office with about 150 people, including many members of the local Armenian community and the California Nurses Assn., which had released statements supporting the family's cause.

    Later in the day, Cigna released a statement approving the transplant payment.

    "Although it is outside the scope of the plan's coverage, and despite the lack of medical evidence regarding the effectiveness of such treatment," spokesman Wendell Potter 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. Our thoughts and payers are with Nataline and her family at this time."

    Nataline died about 6 p.m….

    http://www.latimes.com/news/local/la...nes-california
    I know there are good people and some patient advocates working for insurance companies.
    But they do not provide healthcare.
    And the corporations have a fiduciary duty to the shareholders to make a profit. That is a conflict of interest.
  5. 1
    I suggest that if you want to post an opinion that you read the posts and links first.
    I am sad that one news source got facts wrong.
    …On Dec. 11, four leading physicians, including the surgical director of the Pediatric Liver Transplant Program at UCLA, wrote to CIGNA urging the company to reverse its denial.
    The physicians said that Nataline “currently meets criteria to be listed as Status 1A” for a transplant. They also challenged CIGNA’s denial which the company said occurred because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”
    “So what happened between December 11, when CIGNA denied the transplant, and December 20 when they approved?
    A huge outpouring of protest and CIGNA’s public humiliation.

    Why didn’t they just listen to the medical professionals at the bedside in the first place?” asked Geri Jenkins, RN, a member of the CNA/NNOC Council of Presidents who works in a transplant unit at the University of California San Diego Medical Center….

    …"It is simply not possible to organize major protests every time a multi-billion corporation like CIGNA denies care that has been recommended by a physician," DeMoro said. “Having insurance is not the same as receiving needed care. We need a fundamental change in our healthcare system that takes control away from the insurance giants and places it where it belongs – in the hands of the medical professionals, the patients, and their families."…

    http://www.calnurses.org/media-cente...o.html?print=t
    Letter from Cigna - http://www.calnurses.org/assets/pdf/...ltr_122007.pdf
    HM2VikingRN likes this.
  6. 3
    We pay so much in taxes that everyone should get free care. This is ridiculous to even be debating. Hopefully they will file murder charges against the insurance company like they plan (yes it will contribute to higher costs but will also lead to accountability).

    If a doctor prescribes a treatment then the doctor,nurse, or claims rep at the insurance company should be held accountable for their decision to override the doctor.
  7. 0
    What would UCLA done if she had Medicaid or if she had no insurance? Would they give her the transplant?
  8. 2
    Quote from dmrph
    What would UCLA done if she had Medicaid or if she had no insurance? Would they give her the transplant?
    Since you asked twice I will give the only answer I can.
    I do not know.

    I do know that the family was responsible. They purchased health insurance.
    Simplepleasures and HM2VikingRN like this.
  9. 2
    ...A 17-year-old leukemia patient from Northridge died Thursday at Mattel Children's Hospital at UCLA, hours after her insurance company bowed to a nationwide protest and reversed its earlier denial of a liver transplant....

    ...The Sarkisyans filed an appeal with the California Department of Insurance, which sent a letter this week saying it needed more information....

    http://www.myfoxla.com/myfox/pages/N...Y&pageId=3.2.1

    Video-http://www.myfoxla.com/myfox/MyFox/pages/sidebar_video.jsp?contentId=5281776&version=1&loca le=EN-US
    Simplepleasures and HM2VikingRN like this.
  10. 6
    I can't believe some of the insensitivity here. A CHILD DIED. C'mon people!!!

    I worked for a very prominent insurance company and quit because of stuff like this. I had to tell a woman that her liver transplant was denied because it was "not medically necessary". I saw all of her medical documentation and everything. She had LIVER CANCER. IT WAS MEDICALLY NECESSARY.

    Insurance companies are big time scammers and I am SO glad I don't work for one anymore.


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