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The beauty of healthcare in America

Old 12-21-07, 02:20 PM
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The beauty of healthcare in America

Doctors wanted to give a dying girl a new liver, however her insurance company refused and let her die to save money.


http://www.latimes.com/news/local/la...nes-california
Cigna refused to pay for a 17-year-old leukemia patient's liver transplant until the family staged a protest Thursday, but Nataline Sarkisyan died shortly after the reversal.

A grieving family is blaming an insurance company for the death Thursday of a 17-year-old leukemia patient, who died hours after the company reversed course and agreed to pay for her to receive a liver transplant.

Nataline Sarkisyan was being treated at UCLA Medical Center, where she had been unresponsive in intensive care for about three weeks, her mother said.

"She had a 65% chance of survival if she had gotten the liver," Hilda Sarkisyan said from her home this morning.

The Sarkisyans' insurer, Philadelphia-based Cigna HealthCare, denied the transplant earlier this month.

Doctors at UCLA sent a letter Dec. 11 to Cigna emphasizing that Nataline was eligible for a transplant, Hilda Sarkisyan said. But Cigna refused to pay, citing a lack of medical evidence the procedure would help.

Hilda Sarkisyan said the company was trying to save money. "They just like to collect. They don't want to deliver," she said.

On Thursday, the family rallied supporters online and staged a protest at Cigna's Glendale office with about 150 people, including many members of the local Armenian community and the California Nurses Assn., which had released statements supporting the family's cause.

Later in the day, Cigna released a statement approving the transplant payment.

"Although it is outside the scope of the plan's coverage, and despite the lack of medical evidence regarding the effectiveness of such treatment," spokesman Wendell Potter wrote, "Cigna HealthCare has decided to make an exception in this rare and unusual case, and we will provide coverage should she proceed with the requested liver transplant. Our thoughts and payers are with Nataline and her family at this time."

Nataline died about 6 p.m.

Cigna spokesmen did not respond to e-mail and telephone requests for comment this morning.

The family's lawyer planned a news conference later today to discuss the situation.

Charles Idelson, spokesman for the Oakland-based California Nurses Assns., called Cigna's handling of the Sarkisyan's case "outrageous."

"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?" Idelson said this morning.

He said his group, which represents 75,000 nursing professionals, the majority in California, has recently rallied around a number of patients who have been denied care.

While 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."
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Old 12-21-07, 02:48 PM
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I am sorry, but if that were me or my kid I would have paid out of pocket and went after the insurance company later. WTF is with people that die over stupid red tape?

Pay it, get a loan, mortgage the house, whatever, stay alive at any cost and then battle it out later, or did I miss something?
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Old 12-21-07, 03:00 PM
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Originally Posted by 4KRG
I am sorry, but if that were me or my kid I would have paid out of pocket and went after the insurance company later.


Yes because your average American family (who is paying for insurance) can come up with between 100,000 and 400,000 dollars at a moments notice.

Originally Posted by 4KRG
WTF is with people that die over stupid red tape?
I am curious why you attack the family instead of the insurance company.

Originally Posted by 4KRG
Pay it, get a loan, mortgage the house, whatever, stay alive at any cost and then battle it out later, or did I miss something?
Pay 100,000 to 400,000k out of pocket, man you must be making a nice living to be able to do that. I don';t think most Americans are in that situation though

Last edited by cinten; 12-21-07 at 03:04 PM.
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Old 12-21-07, 03:31 PM
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I'm with 4KRG. I can't imagine money getting in the way of life. I'd give, or do anything for the lives of my children. I'm sure the doctors, and hospital could have worked with the family reguarding payment. I'd go into debt, and fight the insurance company later on.
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Old 12-21-07, 03:34 PM
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I'm hungry & if I don't eat I could die. I feel it's the government's responsibility to feed me...I HAVE THE RIGHT TO LIVE.
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Old 12-21-07, 03:35 PM
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Originally Posted by cinten
I am curious why you attack the family instead of the insurance company.
Personal responsibility?

Someone commits a murder with a gun...do you blame the guy who pulled the trigger or Beretta for creating the gun?
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Old 12-21-07, 03:47 PM
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Being that the OP is a raving lib , I normally disagree with all his views - but I don't see how people think the family could be to blame. They did everything they could have done. They paid for insurance so they would be protected in situations like this, and then when the ins company refused to pay, they staged a protest - and it worked, though sadly too late.

I consider myself secure financially, but I know I couldn't come up with $200k in a week. And I am sure they tried to work something out with the hospital, but that usually don't work out too well.

They got screwed by the ins company, and since there was nothing they could do, their child died. I couldn't imagine being in such a helpless situation.
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Old 12-21-07, 03:51 PM
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I doubt the Hospital would do the job without the money up front. It's not like they could say, bill me later.
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Old 12-21-07, 04:04 PM
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Originally Posted by Chrisedge
I doubt the Hospital would do the job without the money up front. It's not like they could say, bill me later.
Happens all the time. There are even "billing depts." in hospitals.
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Old 12-21-07, 04:12 PM
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I blame George W. Bush and all those evil doctors who try to make money to pay of the thousands of dollars in school loans that they take out in order to become doctors in the first place. And Halliburton...I'm sure they're involved somehow.
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Old 12-21-07, 04:14 PM
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Originally Posted by parrotheads4
Happens all the time. There are even "billing depts." in hospitals.
For planned $200k+ operations? Really? Even if the patients show no ability to be able to pay? You would have thought the hospital would have mentioned this to them.
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Old 12-21-07, 04:18 PM
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Originally Posted by cinten
died shortly after the reversal.[/B]
"She had a 65% chance of survival if she had gotten the liver," Hilda Sarkisyan said from her home this morning.


Doctors at UCLA sent a letter Dec. 11 to Cigna emphasizing that Nataline was eligible for a transplant, Hilda Sarkisyan said. But Cigna refused to pay, citing a lack of medical evidence the procedure would help.
So...what did the doctors have to say about her chance of surviving the procedure? According to the story we get the opinion of both the mother and Cigna...what did they guys in the white labcoats have to say about it? And yes, I realize the UCLA docs said that she was "eligible", but what does that mean?
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Old 12-21-07, 04:19 PM
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Originally Posted by cpgator
They paid for insurance so they would be protected in situations like this
I'm not so sure that is the case here. Apparently there are different levels of coverage and the may not have paid for the better plan. Do we still blame the insurance company if that is the case? If so why not everyone take the lesser plans and then complain when you don't get higher services?

Look at Cigna's response: "Although it is outside the scope of the plan's coverage,..." I have no idea if that is true or not but assuming it is I'm not sure I blame the insurance company even though I look like a heartless bastard by blaming the family for not ensuring themselves properly.
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Old 12-21-07, 04:24 PM
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Originally Posted by cpgator
For planned $200k+ operations? Really? Even if the patients show no ability to be able to pay? You would have thought the hospital would have mentioned this to them.
Do you know that the family had no abillity to pay? In this case the biggest cost may be the surgeons. But yes, it can usually be worked out.
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Old 12-21-07, 04:32 PM
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Originally Posted by General Zod
I'm not so sure that is the case here. Apparently there are different levels of coverage and the may not have paid for the better plan. Do we still blame the insurance company if that is the case? If so why not everyone take the lesser plans and then complain when you don't get higher services?

Look at Cigna's response: "Although it is outside the scope of the plan's coverage,..." I have no idea if that is true or not but assuming it is I'm not sure I blame the insurance company even though I look like a heartless bastard by blaming the family for not ensuring themselves properly.
I agree we do not know all the facts, but it appears that it was outside the coverage because of "the lack of medical evidence regarding the effectiveness of such treatment" and because of the "lack of medical evidence the procedure would help".

I am not aware of too many insurance plans to don't not cover catastrophic situations, since that is usually the point of them.
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Old 12-21-07, 04:37 PM
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Originally Posted by MartinBlank
So...what did the doctors have to say about her chance of surviving the procedure? According to the story we get the opinion of both the mother and Cigna...what did they guys in the white labcoats have to say about it? And yes, I realize the UCLA docs said that she was "eligible", but what does that mean?
"In their letter, the UCLA doctors said patients in situations similar to Nataline's who undergo transplants have a six-month survival rate of about 65 percent."
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Old 12-21-07, 04:59 PM
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Originally Posted by cpgator
"In their letter, the UCLA doctors said patients in situations similar to Nataline's who undergo transplants have a six-month survival rate of about 65 percent."
Only for 6 months? Maybe that's the lack of evidence.
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Old 12-21-07, 05:16 PM
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Originally Posted by MartinBlank
I blame George W. Bush and all those evil doctors who try to make money to pay of the thousands of dollars in school loans that they take out in order to become doctors in the first place. And Halliburton...I'm sure they're involved somehow.
Must not feed sad little trolls....
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Old 12-21-07, 05:22 PM
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Originally Posted by General Zod

Look at Cigna's response: "Although it is outside the scope of the plan's coverage,..."
Cigna considers transplants "experimental" and refused to cover it, because her plan (like most) won't cover experimental treatments, even thought transplants (from what I have heard) have moved beyond the "experimental" stage.

Last edited by cinten; 12-21-07 at 05:26 PM.
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Old 12-21-07, 05:29 PM
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Originally Posted by cinten
Cigna considers transplants "experimental" and refused to cover it, because her plan (like most) won't cover experimental treatments, even thought transplants from what I have heard have moved beyond the "experimental" stage.
They do not consider transplants "experimental". I think you are misconstruing concepts.

If I am slightly overweight and demand my insurance company pay for gastric bypass surgery and they deny it, it is not because they consider gastric bypass surgery "experimental". It's because it's not indicated.
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Old 12-21-07, 05:39 PM
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Well, it is a sad story. Health insurance and hospital billing are pretty complicated issues. Maybe the family just wants to after deep pockets, maybe the procedure was covered but the insurance just didn't want to pay. Who knows, there might be a valid case for a lawsuit.

If the family had taken some loan for the bills, and became broke, the new bankruptcy reform would prevent them getting any help?
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Old 12-21-07, 07:18 PM
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Well, so long as we don't blame UCLA medical.
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Old 12-21-07, 07:32 PM
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They should have gotten Alan Shore on the case.
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Old 12-21-07, 07:40 PM
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The girl has been a vegetable for weeks. The insurance company already paid for bone marrow transplants. It's sad to say but we are all probably better off financially that she's not around anymore. If the transplant had saved her life, what would the result have been? Unconscious life in a nursing home for the next sixty years at taxpayer expense?
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Old 12-21-07, 08:25 PM
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Originally Posted by 4KRG
I am sorry, but if that were me or my kid I would have paid out of pocket and went after the insurance company later. WTF is with people that die over stupid red tape?

Pay it, get a loan, mortgage the house, whatever, stay alive at any cost and then battle it out later, or did I miss something?
These people had to come up with the money not only to save her, but then you have to realize if they spent all their cash for just the surgery, how is she going to live after that. Medical equipment is can easily cost in the hundreds of thousands of dollars when installed in the home, and that's actually cheaper than staying in a hospital.

"Although it is outside the scope of the plan's coverage, and despite the lack of medical evidence regarding the effectiveness of such treatment," spokesman Wendell Potter wrote, "Cigna HealthCare has decided to make an exception in this rare and unusual case, and we will provide coverage should she proceed with the requested liver transplant. Our thoughts and payers are with Nataline and her family at this time."
The insurance company appears to not have any kind of obligation, but thought about it, then actually was kind enough to reverse their decision. The fact the girl died before the surgery could be done, is certainly NOT the issue. The fact the insurance company could have made a decision several days earlier, is NOT the issue. Because if we let this hypothetical into a lawsuit, then we might as well say the insurance company knew the girl was going to die at 6pm, and waited on purpose. Which is certainly NOT the case.

The parents need to grieve, and find another cash cow for their ills and lack of financial creativity.

Oh, and maybe the family should have raised enough money before their girl died.

I blame the family.

While it isn't clear that Cigna could have saved Nataline by approving the transplant earlier, Idelson said, the insurer should have trusted her doctors.
Trusted the doctors. Are these people in a fantasy world, oblivious to what health insurance is? It doesn't mean you can get every fucking procedure done on the planet at the expense of a monthly premium. It's called an INSURANCE POLICY, and they should have read the motherfucker.

Last edited by DVD Polizei; 12-21-07 at 08:28 PM.
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