Cigna officers defend decision to let teenager die

Cigna officers defend decision to let teenager die

rawstory.com

Cigna HealthCare is taking heat this Christmas but isn't backing down after its decision to deny a liver transplant to a teenager afflicted with leukemia left her dead.

Nataline Sarkisyan, 17, died last week after suffering complications following a bone marrow transplant. Cigna had refused to cover a liver transplant the girl's doctors had requested, dubbing it "experimental," only to reconsider at the last minute when the girl's parents had already decided to take her off life support.

(visit the link for the full news article)

As I see it there is one big point in this. The insurance company will make there decisions based on money. I am not an analyst, or bean counter, is the common term. But I think I can safely say every insurance company know what it is worth to them to keep every customer on there account. If you go over your budget, then it is time to get ride of that liability. The news report quoted them as saying "not an effective treatment." Nothing more then preselected words. So it is going to be the insurance companies, or the people who control the money, who will decide if we live or die.

rawstory.com
(visit the link for the full news article)

Insurance companies are always there to hold out their hand for your payment, but when it comes time for them to actually do what they are intended to do, then all of a sudden there are "complications".

Insurance is possibly the biggest fraud ever perpetrated on people. You pay and pay and pay only to have that money not be there when you need it, which is the very reason you were paying them to begin with.

Health insurance is probably the worst. They have control over whether you live or die in some situations. Home insurance, car insurance - these things aren't life and death. Health insurance is.

Everyone should set up a savings account at their bank. Take out of your check how much you would pay to a health insurer and put it in that account. Keep piling it up until the day you need it. That way, you have it and YOU control it. Stop sending your money to big corporations like that. We'll see how long they last if everyone pulls out and handles it on their own.

[edit on 12/27/07 by NovusOrdoMundi]

reply to post by NovusOrdoMundi


Insuring your self as you said, by putting money in a bank account every month. I have heard of people doing it that way. All things considered though, I don't know if that would work now. Like I said in my first post I am not an annalist. So I have not added up what I have paid vs what I would pay if I took care of all of it my self.

i know this is not a life or death like this case but my insurance company(anthem) has been denying my surgery for ore than 1.5 years cause it is 'experimental'.
i had a fusion that failed so i was recomended for an artificial disc replacement and the insurance company said no go.

bastards is what they are.....

reply to post by Boondock78


Boondock
Thanks for sharing your experience, and am sorry that your surgery has been refused for so long. My question is though, is the surgery experimental? Because if that is the case I was under the impression that funding from private sources will often pay for experimental medical treatments.

reply to post by Boondock78


Sorry to go a little off topic, but before you consider having disc replacement take a look at this web site, a friend of my parents had this done and is now living totally pain free. If i had insurance or the money I'd be having it done myself. Anyway have a look, hopefully they might be able to help you.

www.laserspineinstitute.com...

reply to post by SG-1-9er


I know the back is something you don't want to have surgery done to if you can help it, so thanks for posting that link. I hope it will be helpful.

Insurance companies are evil entities ... just like the oil companies and the pharmacuticals. They all claim to be there to help people ... but then they rake folks over the hot coals.

Originally posted by RedGolem
. My question is though, is the surgery experimental?

well i don't know....according to my insurance co which is anthem it is. when i was on the phone with them(the neurosurgeon) said only one company was covering it.

it is a fairly new procedure over here...
all i know is according to my co it is experimental.....i need it but can't get it

reply to post by SG-1-9er


that animation is cool and looks like it would be a good procedure. i am no doc but i don't think it would work for me because i already have a fusion in place that failed. that would have to be removed and the artificial disc put in place.

there is 'cement' back there, a cadaever bone, a chunk of my hip bone and a titanium cage.

Couple of things here just to play devils advocate. No rants about Im in bed with the insurance companies etc either. There are realities that are getting lost in the sensationalism here.

1) The insurance company should have simply allowed it because of the potiental for bad press. Or not reversed itself at the last minute

2) Was it resonable to deny the transplant?: I have been a PICU and RNTS for 13 years now and work in a major if not THE pediatric transplant center in the US so I have alot of experience with this subject matter.

3)The child in question was very very sick and had an iffy prognosis because of her leukemia. The sad part of the matter is that even if she had gotten the transplant she probably would have died. I asked one of our transplant doctors this very question and he agreed that it would have been iffy and would have required a meeting of the ethics board to see if they would even attempt to list such a patient let alone transplant them.

In that light the procedure was indeed experimental and had at best a remote chance of sucess. There also would have been victem had she gotten the transplant That victem would have been the next recipient on the donor list. That organ would be unavalible and most likely the whole exersize may have been futile.

4) What about UCLA? Procedures like that can go on even before the issue of payment is resolved. Happens all the time and in fact a system called CCS exists in California to help pay for the care of such critcally ill children. The matter is that UCLA Transplant Team wanted to do the surgery because it would have generated media attention for thier program and untold academic research oppurtunities. On such iffy procedures reputations are made and carrers ensured. Why didn't UCLA bite the bullet? Because in all likelyhood UCLA did the same cost analysis and said NO much like CIGNA did. Where is the critisim of UCLA? Most major medical centers (UCLA is one of them) have funds and endowments set aside for this type of scenario. Why didn't they use it?



This is a very very complex issue and when you throw children intot he mix, its gets even more complicated and emotional. There is a viceral reaction when kids are involved. However, to simply blame CIGNA in this matter is at best naive. Clearly before we can vilify this company more information needs to be brought to light.

reply to post by FredT


Fred,
Thanks for making the no nonsense knowledgeable post. One thing though, could you please explain what PICU and RNTS is, and what they do?

reply to post by RedGolem



Sorry about that:

PICU = Pediatric Intensive Care Unit
RNTS = Registered Nurse Transport Specialist (Pediatrics)


Its tragic that this child had to die. For that matter any child. I can remember many of the children who seemed like they were going to die that went home from the hospital, but I can still remember EVERY child that I was there for when they died (Be it the actual patients nurse or just helping out). Its a tragedy for all involved.


[edit on 12/30/07 by FredT]

While I agree that she was in not conditions for a major surgery and that death was imminent. . . I always regard the preservation of life as one of the most used and misused issues in this nation.

Plus I regard all type of surgery as experimental no matter what because nobody really knows the outcome of any surgery until the patient wakes up and recover and still is a window of 5 or some years that things still can go wrong.

Originally posted by marg6043
Plus I regard all type of surgery as experimental no matter what because nobody really knows the outcome of any surgery until the patient wakes up and recover and still is a window of 5 or some years that things still can go wrong.

Some I would have to agree. And truth be told when procedures are being worked out it is experimental.

Case in point. There is a rare but lethal cardiac defect in infants known as

Hypoplast Left Heart Syndrome

When I started out, back in 1994 we knew that 90-95 percent of the babies that went to the OR with this defect would die. SOme int he OR some a few days later. Flash foreward to 2007. We do alot of these repairs and if we lose one its a big deal now, Post op survival rate is 90+ percent. The surgeons have refined thier techniques, know what does and does not work, and the post op care has improved. Those were experimental surgeries back in the day.

But in this case, liver transplant is a well established treatment with high survival rates, and reproducable outcomes. So its no longer really experimental. However, in this poor childs case, the leukemia coupled with her overall poor condition made this a experimental int hat there was no evidence that it would hav altered her outcome one bit.

reply to post by FredT


Fred
I can't disagree that there was not evidence the out come would be altered. But in starting this thread the question I wanted to ask is, "will the insurance companies be deciding who lives and dies?" There have been other examples of that very thing happening, but the one I can think of was done by the state. To let the insurance company do it I think is a big mistake.