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

Nurses Activism

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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 818-500-6262 and demand they provide the care Nataline needs.

http://www.calnurses.org/media-center/press-releases/2007/december/life-denied-nurses-family-of-sick-teen-march-on-health-insurance-company-thursday-17-year-old-girl-needs-liver-transplant-cigna-denies.html?print=t

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What would UCLA done if she had Medicaid or if she had no insurance? Would they give her the transplant?

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.

...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/News/Detail?contentId=5278599&version=7&locale=EN-US&layoutCode=TSTY&pageId=3.2.1

Video-http://www.myfoxla.com/myfox/MyFox/pages/sidebar_video.jsp?contentId=5281776&version=1&locale=EN-US

Specializes in Family Practice, Primary Care.

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.

I can't believe you are all educated nurses!.. OK, do you have any idea how many people there are in the USA awaiting organ transplants?.. Do you know how long the average wait for a matching liver is?.. Considering the girl went into failure the beginning of December and the decision was made around the 10th or so that she needed a transplant.. I find it truely amazing that they would find a matching donor the following day! Lets also look at the fact that she had leukemia that would have probably required chemo in the future ( as many of these patients can go in and out of remission).. She was in a vegatative state, which tells me she had multi organ failure...And you are telling me she was a good candidate?.. Come on...It is unfortunate but chances are that this patient was going to die whether or not CIGNA approved the transplant or not.. Transplants are not like blood transfusions.. they take alot of time to arrange and follow thru with.. Please educate yourself. Ignorance is no excuse!. And stop blaming the insurance companys for all your healthcare woe's!

And picture this.. Your doctor walks in your hospital room and says to you " I'm sorry, but I cannot operate because you can't pay me" How cruel is that?.. But that is really what is going on here! How can hospitals and doctors tell patients we can't help you because you can't pay.. How is that any different than the insurance co telling you that?.. And don't tell me they should pay because you are paying them money for coverage.. You are also paying taxes, which pay for the uninsured!( Which of course you cannot take advantage of because you are insured!)

So step away from your pulpit, and open your eyes! I am not without feelings, but if I am going to donate my liver to someone after I die, I want it to go to someone who is going to use it for longer than 5 minutes.. And that 65% survival/.. Exactly how long and what quality of live did that include? Do your homework.

Specializes in Utilization Management.
I can't believe you are all educated nurses!.. OK, do you have any idea how many people there are in the USA awaiting organ transplants?.. Do you know how long the average wait for a matching liver is?.. Considering the girl went into failure the beginning of December and the decision was made around the 10th or so that she needed a transplant.. I find it truely amazing that they would find a matching donor the following day! Lets also look at the fact that she had leukemia that would have probably required chemo in the future ( as many of these patients can go in and out of remission).. She was in a vegatative state, which tells me she had multi organ failure...And you are telling me she was a good candidate?.. Come on...It is unfortunate but chances are that this patient was going to die whether or not CIGNA approved the transplant or not.. Transplants are not like blood transfusions.. they take alot of time to arrange and follow thru with.. Please educate yourself. Ignorance is no excuse!.

Please see Spacenurse's replies to these questions in previous posts. It appears that the patient was in a condition to transplant when an organ was available.

And stop blaming the insurance companys for all your healthcare woe's!

And picture this.. Your doctor walks in your hospital room and says to you " I'm sorry, but I cannot operate because you can't pay me" How cruel is that?.. But that is really what is going on here! How can hospitals and doctors tell patients we can't help you because you can't pay.. How is that any different than the insurance co telling you that?.. And don't tell me they should pay because you are paying them money for coverage.. You are also paying taxes, which pay for the uninsured!( Which of course you cannot take advantage of because you are insured!)

So step away from your pulpit, and open your eyes! I am not without feelings, but if I am going to donate my liver to someone after I die, I want it to go to someone who is going to use it for longer than 5 minutes.. And that 65% survival/.. Exactly how long and what quality of live did that include? Do your homework.

Yes, they should pay because I'm not just paying them money for coverage, I'm paying A LOT of money for coverage that I am not getting because the insurance company keeps telling me that I do not qualify. Or they stonewall the docs and refuse to pay or withhold pay for months, for no good reason. Our hospital recently dropped a provider because they did exactly that -- they never paid the docs.

My insurance company actually withheld reimbursement to my doc because for months, they argued about my son's birthdate. My doc did not get reimbursed for over a year for a simple office visit! The office called and even I wound up calling the insurance company at least four times to get the problem resolved but each time, everyone had the correct information, yet the money sat at the insurance company, costing my doc's office more money to try to obtain.

This happened with a child who's been sick enough to see a doc exactly 10 times in his life and he's now 18. I cannot imagine what people whose children are really sick go through.

As for the "doing your homework" part of your post, if the girl qualified to get a liver, her case had to jump through numerous hoops in order to qualify. They don't just recommend transplants for everyone, believe it or not. She was eligible and the family has a case. Time was of the essence in her case, and every standard of care calls for timely treatment.

What good is an appendectomy after the patient dies? Same principle applies here.

The insurance company needs to bear some of the responsibility for this girl not getting the timely treatment that was recommended by her docs and cleared by the transplant committee.

As far as "homework" is concerned, I believe that had she had the transplant, the insurance company realized how long her life would be, all the while having to take expensive medications and other treatments for years, and that is why Cigna initially denied her.

Because it's all about the money, isn't it.

Insurance companies are in it for the money. Period. The corporation does not care about individuals. The corporation cares about the bottom line. Yes, I agree that a lot of the physicians are in it for the money too. I've seen the Audis and Jaguars driven by a lot of them. But I also know that many of the executives of hospitals and insurance companies have two homes and several high-end cars. I work for a for-profit company, and I don't for a minute believe that they care about the individual patients. I care about my patients, but the powers that be are motivated by profits.

I'm really sorry that the girl died. However, I still wonder about how good of a candidate she really was. If she was cured of the leukemia and had no other co-morbidities, and no other organ failure, then I suppose she might have been a good candidate. If that were the case, then CIGNA should have covered it and not delayed treatment. Insurance companies DO delay treatment on purpose. If they wait long enough, maybe the patient will die, and the point will be moot. :nono: And insurance companies don't like to pay to prevent illness. It seems like a no-brainer to me that they would save more precious dollars by paying for preventative measures, but apparently some bean counter has figured that it doesn't make for good profits to help keep people healthy.

I wish I could have been a fly on the wall as this situation was going down. When I worked for a large academic facility prior to becoming a nurse, I saw firsthand how physicians could sometimes be pressed to pursue futile treatments. With the talk about a vegetative state, I just can't help but wonder if that were not the case here.

The information currently available probably raises more questions than answers.

How often have I, like my fellow nurses, been comforted that we did the best we knew how attempting to save a patient. Especially a child?

Videos:

Her brother did this one -

Interview with David Cordani, President, Cigna HealthCare -

Was she truly in a vegetative state? Or was her LOC related to something else, reversable? I just saw on the 2nd youtube video from ABC, that she was SEDATED into a coma, this IS reversable, Yes?

The distraut mother used the term vegetative state.

The father said she was sedated.

The pictures on the brothers video taken after the BMT show her alert, wearing a scarf.

Specializes in Family Practice, Primary Care.

Also, after working at an insurance company, I have seen some horrid things. Claims get denied for NO reason and a member will not find out about it until their doc tells them about it, and it may be too late to have the claim reprocessed etc.

I also used to bump claims up to be reprocessed if a member had been waiting for than 4 weeks because I was told they would "just have to wait". How nice!

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