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Paraphrasing: this girl needed a liver transplant and the insurance company denied her. They later approved it, but it was too late - she died before the operation could begin.
I understand that for some people, the insurance business works. You know, become marketable, take responsibility, get a good job with good benefits.
This girl was 17 - a minor. This was beyond her control, but she paid the price. In a country with a NHS, she would've gotten the transplant immediately because it was urgent for her life. Instead, there was the insurance run around.
Mods: I put this in the controversy section so we could discuss how the health system is corrupt. If you need to move it, please do so.
this is very sad indeed. I can tell you from what others with MS have said that are in a country with a NHC system, treatment for MS certain medications that have been proven to help slow the progression are not obtainable, due to the cost of the medication. My insurance company is going to approve the use for me. so there is my story of the benifits of a private system.
There definatly needs to be reforms in the way the system is working now, but I do not feel that a national healthcare system is the way to go.
I know you feel you had some bad experiences in the UK personally, but other posters have posted that they had more positive experiences. And they are ranked 18 in the world by the WHO for health care, we are 37.
In any case - I am not trying to make this another "let's have a national health care debate.
Do you agree that insurance companies should be able to reject coverage for procedures that medical experts agree are viable operations for the symptoms of the patient and are covered under the insurance terms for the patient? In this case the insurance company - after it first approved, then later denied the procedure, apparently did so on the grounds it was "Experimental" when the doctors said this was not the case at all. What should the ground rules be?
Why don't I just let you write them so everybody gets their way and nobody can afford insurance anymore.
This is very sad but it's like so many other incidents that happen in this country because of our healthcare system. Insurance companies should not exist... they are pure evil. What should be the goal in healthcare? To take care of the sick. What is the goal of insurance company? To make a profit. These two goals obviously clash! If you take care of the sick, you have to spend more money which means less profit. It's like a tug of war... people vs insurance companies, and so far it's obvious people in america don't stand together to battle against the companies so they continue to suck as much out of the working americans as they can.
And good luck once you start getting older. Then they just start denying your claims until hopefully, you die.
But what's wrong with that? A company has to make money, right?
Interviews by The New York Times and confidential depositions indicate that some long-term-care insurers have developed procedures that make it difficult — if not impossible — for policyholders to get paid. A review of more than 400 of the thousands of grievances and lawsuits filed in recent years shows elderly policyholders confronting unnecessary delays and overwhelming bureaucracies. In California alone, nearly one in every four long-term-care claims was denied in 2005, according to the state.
“The bottom line is that insurance companies make money when they don’t pay claims,” said Mary Beth Senkewicz, who resigned last year as a senior executive at the National Association of Insurance Commissioners. “They’ll do anything to avoid paying, because if they wait long enough, they know the policyholders will die.”
Some employees describe vast mailrooms where documents appear and disappear. One call-center representative said he was afforded an average of only four minutes to handle each policyholder’s call, no matter how complicated the questions. Employees said they were instructed not to say when the company was behind in processing paperwork, even when the backlog extended to 45 days. Workers were prohibited from contacting each other by phone, although such calls might have quickly resolved obstacles, according to depositions.
Bureaucratic obstacles were pervasive, according to interviews with 10 former Conseco employees and depositions of more than a dozen others. Robert W. Ragle, a former Bankers Life branch manager, once contacted the claims department on behalf of a client, and “they just laughed us off the phone,” he said. “Their mentality is to keep every dollar they can.” Mr. Ragle was dismissed by Bankers Life in 2002. He sued for wrongful termination and settled out of court.
If this could happen to her, this could happen to any one of us, right? For most of us this is a hypothetical question. It's easy to form opinions and judgments when it's not happening to you.
But what if you find out you may need a bone marrow transplant? Would your views on this horrible incident change?
Would you wonder if your own insurance company will fail you if you were to have liver complications from the transplant? Would you roll the dice and see if it all worked out?
Should you start saving now for the hundreds of thousands it would cost you if they did refuse to pay for treatment? Would you have enough credit on your credit card?
Or would you refuse a transplant entirely because you've lost all faith in our health care system?
In Washington they recently passed a referendum... so that if an insurance company refused a claim that turned out to be legitimate, they would have to pay 3x the claim amount if a court found them to be negligent in not paying the claim. The insurance companies tried to fight it by scaring the public into thinking their rates would go up due to frivolous lawsuits, but the insurance commissioner came out and said this was not true, and that if the companies just paid the damn claims like they are supposed to, there would not be a lawsuit filed. So there are some actions consumers can take for protection.
The insurance company reversed it's decision and said yes. The patient died.
If she was in such an unstable state she probably would not have survived the surgery anyway. And beyond that I don't believe the doctors would have performed the transplant if she was in this condition.
It is one thing for doctors to state that a patient needs a transplant to survive. It is another thing completely for them to agree to the surgery. The patient would have to be stable.
There is a lot of criteria a potential transplant candidate must meet before they are given an organ. Pointing the finger at the insurance company seems to me an outlet to cast blame on someone for this young girls death.
We also dont know why they changed their decision, was it based upon the doctors providing more information that was not available in the first submission for request? Not enough information
Why? She'd have died waiting for a liver anyway. From what I heard on the news, she was on the UNOS list only for a few weeks. The average wait time is almost a year. Her death is not CIGNA's fault.
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.
We also dont know why they changed their decision, was it based upon the doctors providing more information that was not available in the first submission for request? Not enough information
This was all provided in an earlier link. The girl developed a lung infection. The doctors said this would not increase the risk to the transplant procedure and they could still move forward. However the insurance claims adjuster decided it was too risky and turned around and denied the previously approved procedure.
I wonder what medical degree the claims adjuster has... to go against the recommendations of the medical professionals.
They already had a match...and the bigger question is what the heck is the insurer delaying treatment the doctors claim is necessary and proper in the first place?
The Sarkisyan family claims that Cigna 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.
"They're the ones who caused this. They're the one that told us to go there, and they would pay for the transplant," Hilda Sarkisyan said.
Geri Jenkins of the California Nurses Association said the Sarkisyans had insurance, and medical providers felt comfortable performing the medical procedure. In that situation, the the insurer should defer to medical experts, she said.
"They have insurance, and there's no reason that the doctors' judgment should be overrided by a bean counter sitting there in an insurance office," Jenkins said.
Doctors at the UCLA Medical Center actually signed a letter urging Cigna to review its decision. Nataline Sarkisyan was sedated into a coma to stabilize her as the family filed appeals in the case.
The insurance company did not delay treatment, the doctors and hospital did deny services while waiting for payment. Where is the outrage against the hospital? I know.. lets use this as an argument for NHS, then when that happens, and the same things happen, we can start a national right to public hospitals, doctors offices, and simply put all of the doctors etc onto the public payroll also.
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