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More then likely yes, she would have died anyways, or a transplant just not been available. I just think that they are entitled to have their day in court, and CIGNA should defend their denial based upon information known at that time, and their contract for services.
A transplant was already available. They were ready to operate.
"She probably would have died anyway"... does not sound like much of a defense. Some people are obviously "a-ok" with it though. What are the odds it will happen to us or our immediate families, right. Got to make sacrifices for the greater good.
A transplant was already available. They were ready to operate.
"She probably would have died anyway"... does not sound like much of a defense. Some people are obviously "a-ok" with it though. What are the odds it will happen to us or our immediate families, right. Got to make sacrifices for the greater good.
Then they should have operated. Again, who denied services? The hospital did.
Then they should have operated. Again, who denied services? The hospital did.
Sure, you can give them some of the blame. This happens every day. Health Care Providers and Insurance Companies haggle over the bottom line while patients wait to get some treatment. Sure puts a spin on the old adage "Everyone in the Country can get Health Care", doesn't it.
More then likely yes, she would have died anyways, or a transplant just not been available. I just think that they are entitled to have their day in court, and CIGNA should defend their denial based upon information known at that time, and their contract for services.
I think it will be interesting, though CIGNA is certainly not the only insurance company to deny organ transplant coverage due to the fact that it's an "experimental" treatment.
I don't think CIGNA really contributed to this girl's death, though they are an easy target for blame with deep pockets. It will be interesting to see how this plays out....to see if this suit will change anything in the way insurance companies are run. In the end I doubt it; CIGNA will probably settle rather than risk a far more expensive judgment that could change the way they do business.
Then they should have operated. Again, who denied services? The hospital did.
That's a ridiculous comment. Nothing is free in this society. If they provide the service, who absorbs the costs? Hospitals? Doctors? State? Government? Tax payers? The insurance company gets away with making billions, yet you put the blame on hospitals. If they did operate, that'll just start a whole avalanche of rejected claims. Since somebody else is taking care of the cost anyway, why should they? Who wouldn't want free money every month for doing nothing?
That's a ridiculous comment. Nothing is free in this society. If they provide the service, who absorbs the costs? Hospitals? Doctors? State? Government? Tax payers? The insurance company gets away with making billions, yet you put the blame on hospitals. If they did operate, that'll just start a whole avalanche of rejected claims. Since somebody else is taking care of the cost anyway, why should they? Who wouldn't want free money every month for doing nothing?
Why do some people continue to try to make this a national health care debate. That is another thread, completely irrelevant to this topic.
Let's try to focus on the op... which is highlighting the issues that come into play when an insurance claims adjuster makes life and death decisions that go against the medical professionals' recommendations, and the person "supposedly" was insured for the procedure.
Let's just try to admit there are some serious problems that need fixing, this being an excellent case in point. Aside from "well she probably would have died anyway"... per some of the medical experts we have posting here.
People, people, people . . . I understand the hatred of insurance companies, but try to be reasonable and get all the facts. This makes a good "insurance companies evil" story, but it's just not true. This girl was not a candidate for a liver transplant, period. I'm sorry that there were so many ignorant nurses protesting with their signs; they should know better, and it's embarrassing that they display their lack of medical knowledge to the public. There were a few doctors who supported the surgery (guess who gets paid the big bucks for performing this transplant?) but let's hear from all the doctors who would have stated frankly that this transplant in a cancer patient is ABSOLUTELY CONTRAINDICATED. The immunosuppressive drugs required to prevent rejection of the transplanted liver would have resurrected her leukemia. More chemo to deal with the resurgent leukemia would have caused her new liver to FAIL, as it is the liver that metabolizes most chemotherapy drugs. As others have pointed out, livers are in short supply and not everyone who is on the transplant list will get one. Various criteria are examined to determine who should get a liver. Patient acuity is only one of them -- prognosis is another. This girl's acuity was high, but her prognosis was poor. It would have been a poor choice to give her a liver (to say the least) and some other person whose chances were better would have died for having been denied the liver.
Use your brain instead of your emotions, that's all. This is not a case of an evil insurance company perpetrated tragedy. This is a case of wanting to find a scapegoat, and, well, everybody hates an insurance company. I have every confidence that the insurance company will win in a court of law, because they have done nothing wrong. In fact, I find myself in the unexpected position of admiring their decision for once.
Also, organ transplantation is not considered "experimental" and that is not why this was denied. Organ transplantation UNDER HER SET OF CIRCUMSTANCES was what was deemed "experimental." Indeed, because we don't give donated organs to people who are actively battling cancer. Remember that it was her medical treatment that caused her liver to fail in the first place, and a new liver would have failed for the same reasons.
You know chattypatty, maybe you are right about her prospects. And the family will probably not go far in court, I agree. But then tell me how it is supposed to work. If you have medical insurance that is supposed to cover the transplant, the insurance company initially approved it, a transplant donor is found, the nurses and doctors are all onboard and ready to go, and then the insurance company turns around and denies it. The actual doctors that were going to perform the surgery dispute the "experimental under her condition" argument proposed by the insurance company.
Because this is not an uncommon occurrence at all, the only thing that makes it a sensational story here is that the girl in fact died. The larger problem is that insurance companies do in fact play doctor and deny valid claims all the time. What recourse do people have?
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