Calif. teen's family sues Cigna over transplant

  1. 3
    calif. teen's family sues cigna over transplant

    2008 the associated press

    dec. 26, 2008, 5:56pm

    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.

    but charles idelson, a spokesman for the california nurses association, said insurance companies are "in business to provide profits for shareholders, not to provide care."

    full story: http://www.chron.com/disp/story.mpl/...n/6182733.html


    a statement written by her mother is available at:
    http://www.calnurses.org/media-cente...natalines.html

    a video about the fight to save nataline is available at:
    http://www.youtube.com/watch?v=mcgm0...e=channel_page

    the approval letter from cigna can be found at:
    http://www.calnurses.org/assets/pdf/...ltr_122007.pdf
    Last edit by brian on Dec 30, '08
    Valerie Salva, herring_RN, and Atheos like this.

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  2. 26 Comments...

  3. 3
    Very sad....that is why I don't have an HMO for health coverage. Although this appears to be a trend with most all health insurance these days. My heart aches for her mother to feel sooooo helpless and not be able to save her childs life due to red tape and greed....absolutely pathetic and shameful for Cigna. Perhaps some heads will roll...... Makes me very very angry.
    jsrRN, herring_RN, and lindarn like this.
  4. 3
    I work in a pediatric office, and we see things like this daily. Most insurance companies now don't want to pay for vaccines or they will pay for like $250.00 worth of vaccines which is nothing for a baby. They also are cutting well care coverage. It's pathetic.
    jsrRN, herring_RN, and lindarn like this.
  5. 5
    Personally, I think the biggest mistake Cigna made was reversing itself and offering to pay for the transplant. Their original conclusion was correct: this patient was a poor candidate and giving her a liver would have been a waste of a precious resource. Why her physicians offered to do it in the first place is beyond me.
    Valerie Salva, EricJRN, Batman24, and 2 others like this.
  6. 3
    Quote from TiredMD
    Personally, I think the biggest mistake Cigna made was reversing itself and offering to pay for the transplant. Their original conclusion was correct: this patient was a poor candidate and giving her a liver would have been a waste of a precious resource. Why her physicians offered to do it in the first place is beyond me.
    Given that HER physicians who actually examined her and knew all the circumstances of her case said she qualified for the transplant, I don't get why you think you can call the case. Or are you like Bill Frist who can diagnose Terry Schiavo's brain health after viewing her in edited video? And please recall he was 100% wrong.
    jsrRN, Valerie Salva, and herring_RN like this.
  7. 1
    Transplants are experimental?????????????????
    herring_RN likes this.
  8. 0
    see next post.................:typing
    Last edit by haras regnurps on Dec 30, '08
  9. 6
    As a former Liver Transplant team member I can only say cudos to the family. It takes alot of guts to go up against the big guys..........tho I am sure that their lawyers probalby found the family to take the case ( just a hunch )
    The insurance industry has been backpedaling for years and we as nurses all know it. You see the abuse everyday in whatever system you work in public private,-Hospitals, Doctors' offices, home health, it is everywhere.
    This patient may not have been the most ideal candidate for a transplant but she was a candidate according to her doctors. Livers by the way do not just drop out of the sky............it sometimes takes weeks, months to get one. By refusing to pay and therefore not allowing her to be even put on the list -they delayed treatment !
    A catastrophic error on their part. Reversing their original decision is going to cost them in court. My guess is that it will cost them big time. Wish that I would be getting the paychecks of just one of the lawyers involved with the case because at least they will get paid.
    jsrRN, Valerie Salva, caycay, and 3 others like this.
  10. 1
    Quote from BabyLady
    Transplants are experimental?????????????????
    Transplants aren't really considered experimental anymore
    herring_RN likes this.
  11. 2
    A lot of information on the web about HMO's now and quite a bit negative.. http://www.makingakilling.org/chapter1.html .. some seem to go so far as to dictate the treatment options a doctor can discuss with their patients. IMO this is very sad.
    herring_RN and Ludlow like this.


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