17- year-old girl needs liver transplant, CIGNA denies - page 7

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... Read More

  1. by   greygooseuria
    To make the assumption that insurance companies aren't in this for profit is very, very misinformed and using clouded judgment, or that someone has a vested interest in insurance companies doing well.

    When it comes down to it, I'd rather have socialized health care. My grandfather got a hip replacement in May and has severe rheumatoid arthritis and it didn't cost him a dime and he had to wait all of 2 weeks to get it. I think the US can do it. We pay about equivalent taxes as they do in Canada yet they have so much more.

    How about this for an idea? We stop pissing the rest of the world off so much so we have no need for a military!
  2. by   jeolsz
    Hey Cocoa girl....None of us at the big bad insurance company decide on patient care... the only desicions that are made are whether to PAY for procedures, hospitalizations, etc.. An insurance policy is a product that is sold to a consumer.. It's like buying a house.. It doesn't always include the appliances and window treatments, if you know what I mean.. read your policy.. It will fully explain the rules and what is included in your policy...

    And also remember everyone is in it for profit, not just the insurance companies.. remember that no one works for the pure fun of it.. we are all motivated by the need to support ourselves and our families.. and for every CEO you can site, I can also site a rich doctor...

    Just remember, insurance companies do not deny treatment, they deny payment for procedures and hospital stays that are not medically necessary.. they base this on studies and medical literature and on medically approved criteria, not on a whim.

    CIGNA did not make the decision not to do the transplant.. the medical staff and the hospital made that decision.. If the patient was uninsured, this story would have never made the papers.. but since a big insurance co was involved, its all the sleeze that's fit to print...

    Trust me Michael Moore's movie Sicko has more to do with his ego than the current state of our healthcare system.. Unfortunately it's his simpleton logic and slow paced , easy to understand cartoon effects that appeals to the largely unworldly and ignorant masses.. As you can probably tell, I'm not a large fan of a man who makes millions, yet pretends he's one of us!

    I don't know, I learned along time ago in college, DON'T BELIEVE EVERYTHING YOU READ! I think it was one of the first things I was taught.. You don't have to agree with me, and believe me, I've thought the same as you a few years ago.. But I have the benefit of seeing the other side.. and believe it or not I didn't see any horns or pitchforks ( although it was alittle hot in the office there.. or could just be the hot flashes I've been getting lately!)

    The world is not always so black and white. Just remember there are always 2 sides to every story...
    Last edit by Thunderwolf on Dec 24, '07 : Reason: disrespectful finger pointing discredits one's own post, twas removed
  3. by   greygooseuria
    jeo, in case you hadn't read my posts, I have also worked for an insurance company and disagree with everything you've said.

    I've seen SiCKO and most of it is true. Maybe it is not we who are wrong, but you. You are very, very quick to cast stones and are coming off as very defensive. I'd look within for these reasons.
  4. by   Simplepleasures
    Quote from jeolsz

    and also remember everyone is in it for profit, not just the insurance companies.. remember that no one works for the pure fun of it.. we are all motivated by the need to support ourselves and our families.. and for every ceo you can site, i can also site a rich doctor...whatever happened to honor, human decency, no shame in making a profit, but not off the back of your fellow man.

    trust mewhy? michael moore's movie sicko has more to do with his ego than the current state of our healthcare system.. unfortunately it's his simpleton logic and slow paced , easy to understand cartoon effects that appeals to the largely unworldly and ignorant masses.. as you can probably tell, i'm not a large fan of a man who makes millions, yet pretends he's one of us!but you seem to like the health insurance corporations, they make billions off of denial of payment schemes.
    this is a sad commentary.
  5. by   HM2VikingRN
    Quote from jeolsz

    The world is not always so black and white. Just remember there are always 2 sides to every story...
    Why work for this?




    The reality remains the following:



    We spend 2.5 times that of the UK and have worse health outcomes.

    Cost related access problems contributed to the death of this girl:

    Last edit by Thunderwolf on Dec 24, '07 : Reason: Quote of quoted member edited
  6. by   ElvishDNP
    Friendly moderator note:
    All of us who care about our patients and want the best for them (all of us, right?!) are sickened that a 17yo girl has died from liver cancer. That breaks the heart of the biggest and baddest of all of us.

    Please, let us discuss that issue and and the issues surrounding without attacking one another. If you need to, take a deep breath and count to 10 before clicking 'reply', and if you really can't do that without turning the post into an attack, it may be best to just 'walk away' from it.

    This has so far been a very interesting, enlightening discussion, and we don't want to close the thread. Please keep things nice. Thanks.
  7. by   MBANurse
    My wife is a transplant coordinator... she states that it is VERY unlikely that they in fact had a liver lined up that would have saved her.

    Coupled with the fact that she had leukemia; ACTIVE leukemia; that the treatments for destroyed her liver in the first place... why would a transplant agent assign another liver to be; pardon my insensitivity; wasted? It is indeed tragic that the young lady passed away. But if a far better canidate got the liver and lived isnt that a better outcome than both of them dying?

    Just my two cents
  8. by   Patrice13
    I have been following this forum for a couple of days now. I have a few questions to ask.

    How can you say that its wrong for the insurance companies to be for profit, but still get that direct deposit in your checking account every two weeks? Doesn't that make us all "for profit"?

    How much did you hospital or university make last year, and I'm talking profits not revenues?

    The reality remains the following:
    Take a closer look at that chart. We have the best any country has to offer and the only spot that is white is the issue of whether or not patients are getting the right care for their ailments. That is what puts the money issue over the top. We spend almost double because we provide them more care then is necessary which is paid out by the insurance companies. So if you want to cut costs and make a better healthcare system we need the people who can analyze data objectively and allocate resources the way they need to be to be most cost effective and beneficial to our population.

  9. by   pickledpepperRN
    Girl Denied Healthcare Coverage, Dies; CEO Makes $21 Million

    http://sec.edgar-online.com/2007/03/.../Section16.asp
  10. by   pickledpepperRN
    Tough calls in transplant case
    December 22 2007

    ...Dr. Goran Klintmalm, chief of the Baylor Regional Transplant Institute in Dallas, said the operation that UCLA wanted to perform was a "very high-risk transplant" and "generally speaking, it is on the margins."

    But Klintmalm said he would consider performing the same operation on a 17-year-old and believes the UCLA doctors are among the best in the world.

    "The UCLA team is not a cowboy team," he said. "It's a team where they have some of the soundest minds in the industry who deliver judgment on appropriateness virtually every day."...

    ..."If Cigna could approve the transplant yesterday in response to hundreds of phone calls and people pounding on their door in Glendale, why couldn't they have done it eight days earlier?" said Charles Idelson, spokesman for the Oakland-based group.

    Although it isn't clear that Cigna could have saved Nataline by approving the transplant earlier, Idelson said, the insurer should have trusted her doctors.

    "The transplant was recommended by the medical professionals at the bedside," Idelson said. "They should have been listened to."...

    http://www.latimes.com/business/la-f...lines-business
  11. by   HM2VikingRN
    Quote from Patrice13
    I have been following this forum for a couple of days now. I have a few questions to ask.

    How can you say that its wrong for the insurance companies to be for profit, but still get that direct deposit in your checking account every two weeks? Doesn't that make us all "for profit"?

    How much did you hospital or university make last year, and I'm talking profits not revenues?

    The reality remains the following:
    Take a closer look at that chart. We have the best any country has to offer and the only spot that is white is the issue of whether or not patients are getting the right care for their ailments. That is what puts the money issue over the top. We spend almost double because we provide them more care then is necessary which is paid out by the insurance companies. So if you want to cut costs and make a better healthcare system we need the people who can analyze data objectively and allocate resources the way they need to be to be most cost effective and beneficial to our population.

    Ths simple fact is that our health care system ranks SIXTH overall of SIX. The UK ranks second on the "right care dimension" , spends 40% of what we spend and is number one overall for quality. I have looked at this chart several times and the lesson to be taken from this chart is that we can learn quite a bit from other countries about how to make our system work better. If we truly want to make our system the best in the world we would look at what works better in other countries and adopt that for our own system as we work through the redesign.

    Quality care- What can the UK teach us?
    Safe Care-What can we learn from the Germans?
    Coordinated Care- What can we learn from the UK?
    Patient Centered care-What can we learn from New Zealand?
    Efficiency/Equity-How does the UK differ from us?
    Long healthy productive lives-What is Australia doing right?

    There are lessons to be learned from the world stage that would be well worth our taking the time to learn and adopt.
    Last edit by HM2VikingRN on Dec 24, '07
  12. by   Noryn
    I just want to see some credentials here. We have some posters saying these transplant doctors at UCLA (who are likely among the best in the world) are wrong.

    It is funny the insurance people claim that before they came to be that there was a ton of waste, yet in the past 20 years look at the overall care in hospitals along with the hospitals that are closing. I wonder how much of it was actually waste. We have lost 3 hospitals I know of in my area in the past 10 years or so.

    But again, I want to see these people who denied this claim to be held accountable in a court of law. Let's see what proof the insurance company has that this would not have saved her life.
  13. by   Jolie
    Quote from Noryn
    But again, I want to see these people who denied this claim to be held accountable in a court of law. Let's see what proof the insurance company has that this would not have saved her life.
    As upopular as this post may be, it is not necessary for the insurance company to prove that the procedure wouldn't have helped this girl. If CIGNA is sued, it will only be necessary to prove that the transplant wasn't covered by her policy. Regardless of the seriousness of an illness or the cost of treatment, insurance companies don't have to pay for what a policy doesn't cover, experimental procedures included.

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