Cancer Girl's Lawyer Blames CIGNA For Her Death

[CptSternn]

http://cbs2.com/local/nataline.sarki....2.615167.html

Cigna HealthCare "literally, maliciously killed" Nataline Sarkisyan, attorney Mark Geragos told reporters in downtown Los Angeles.

Sarkisyan died at 5:50 p.m. Thursday after being pulled off life support at UCLA Medical Center.

Geragos said Cigna twice took Sarkisyan off the liver transplant list
and purposely waited until she was near death to approve the transplant because the company didn't want to pay for her after-care.

Cigna announced yesterday -- just hours before the girl died -- it would pay for the transplant. "Cigna decided that they were going to take profits over this little, beautiful princess' life," Geragos said. "We believe that they single- handedly decided that they wanted to have her die and wait so they would not have to take the after-care coverage."

Geragos said a civil lawsuit would be filed and he plans to petition
District Attorney Steve Cooley to pursue murder or manslaughter charges against Cigna. "I believe that it's criminal and this corporation should be held accountable," Geragos said, adding this could be a "test case" because no such criminal complaint has yet been brought against a health insurance company.

In a statement issued yesterday after it had approved the transplant, the
company said the procedure "was outside the scope of the plan's coverage."
"... and despite the lack of medical evidence regarding the
effectiveness of such treatment, 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 prayers are with Nataline and her family at this time."

Sandi Gibbons, spokeswoman for the District Attorney's Office, said it
would be inappropriate to comment on any possible criminal charges against Cigna since Geragos has yet to present anything to prosecutors.

Sarkisyan's 21-year-old brother, Bedros, told reporters that UCLA had a
liver available for transplant, but they could not perform the procedure
because of Cigna's refusal to cover it.

The girl's father, Krikor Sarkisyan, held a photograph of his daughter,
and with his eyes wet with tears, cried out. "They took my daughter away from me!"

"The Cigna people, they cannot make people's decision if they (are)
going to life or die," he said through a heavy accent. "Doctors ... they all
signed the papers. ... Cigna denied it two times."

Cigna insurance initially declined to pay for the transplant for Nataline Sarkisyan because her plan did not cover "experimental, investigational and unproven services," her doctors said.

The denial prompted nationwide protests, including a rally outside
Cigna's Glendale offices yesterday and complaints by members of the California Nurses Association. About 15 minutes into the rally, Cigna announced it would approve the transplant.

But last night, Nataline's parents had her removed from life support at
Mattel Children's Hospital at UCLA"because her condition was hopeless,"
family friend Steve Artinian told reporters.

"Now we have to start the healing process to try to figure out what
happened and why it happened," Artinian said.

A state and national nurses organization blasted Cigna's decision to
deny Nataline's transplant. "Why didn't they just listen to the medical professionals at the bedside in the first place?" said Geri Jenkins, a registered nurse and member of the California Nurses Association/National Nurses Organizing Committee Council of Presidents. "Insurance companies have a stranglehold on our health," said CNA/NNOC Executive Director Rose Ann DeMoro. "Their first priority is to make profits for their shareholders and the way they do that is by denying care."

Nataline had been in a vegetative state for three weeks, according to
her mother, Hilda Sarkisyan. The girl was diagnosed with leukemia at age 14.

After two years of treatment the cancer went into remission but came back this summer.

When doctors said Nataline could use a bone-marrow transplant, the
Sarkisyans discovered that her brother was a match, and he donated his bone marrow the day before Thanksgiving.

However, Nataline developed a complication from the bone-marrow
transplant and, because her liver was failing, doctors recommended a
transplant, according to an appeal letter sent to Cigna earlier this month.

The Sarkisyans filed an appeal with the California Department of
Insurance, which sent a letter this week saying it needed more information.

Then came the protests and the insurance company's decision to approve
the liver transplant, but by then it was too late for Nataline.

Friday, CIGNA released the following statement: "Our deepest sympathies are with Nataline's family. Their loss is immeasurable, and our thoughts and prayers are with them. We deeply hope that the outpouring of concern, care and love that are being expressed for Nataline's family help them at this time."

[CptSternn]

Watching the American news you see the right wing republicans forecasting gloom and doom if they change the healthcare system. They claim the government will be able to choose who lives or dies. In fact, ex-governor palin said just that on a press release yesterday.

They also continue to repeat over and over 'do you want the government making choices for your doctor'?

Stories like this are not unique. NBC news did a bit on this a few weeks ago where they had a half dozen people with various diseases or ailments that were denied healthcare due to the fact their insurer thought it cost too much.

The republicans, and their supporters against changing the system, are intentionally looking over the cold hard fact that money making corporations are currently making decisions on who lives or dies, based on the companies bottom line.

Healthcare should NOT be a money making industry. The government should run it - as they do fire brigades and ambulance services. Would you feel better if when you called 911 you knew companies were involved? Would you sleep better at night if you thought you might not be able to have the fire brigrade put out a fire in your home or the ambulance you call might not show up because it is more profitable for them to go elsewhere?

Of course you wouldn't. So it amazes me people do not make the same distinction when talking about healthcare in America.

Letting the government run things, removing the for-profit factor and having it like the other current socialised services like fire and ambulance only makes sense.

[HumanePain]

Unfortunately there are sufficient numbers of brainless lemmings following Rush Limbaugh's marching orders to use Nazi brown shirt shout-down tactics at town hall meetings, to artificially make the impression that Americans don't want health care reform. Bastards.

[CptSternn]

The only way they can attempt to stop reform is to keep people from actually discussing it.

That right there speaks volumes...

[Underwater Ophelia]

I have cigna healthcare.

[CptSternn]

Don't get really sick - you might find you don't have coverage, thanks to the company men who tow the line and watch out for the companies stock profits.

I mean, companies are made to make money. If they stop making money, they fired the CEO and change the board members. CEO's make HUNDREDS of MILLIONS a year (your insurance premiums at work right there). How can anyone support a health care system which is built on the idea of turning multi-million dollar profits EVERY year? It's guaranteed to screw more and more people each year in efforts to keep the bottom line profitable, else they will bring in someone else who will make the company profitable.

It's sad to see people on the news fighting to keep that system, having no real clue about the subject matter at hand, regurgitating what they pick up from right-wing nut talk show hosts (who hold large chunks of stock in said companies and have free healthcare thanks to the large companies they are employed by).

[ShadowxMakerZ]

If you've seen Drag me to hell then you'll understand perfectly what was going on. Lets just hope the one who denied the claim for an attempt to continue profitting does indeed get dragged to hell.

Ass*holes

[carol8]

this is another reason why I don't trust insurance,all consumer seems always need lawyers to handle all there papers and claims,it so wasting time and money

[Solumina]

We were on Cigna for a while, my mom did get very sick, we never had a single problem getting them to cover her treatments. The thing is that they lay out what they will and will not cover, there are other things that can happen and they will take that into consideration but it takes time for them to approve such things. I hate to say it but what the family needed to do is suck it up and pay for the procedure (or set up a payment plan with the hospital if they could not afford it, which is likely as transplants are quite costly) and then have Cigna reimburse them after approval for an exception is made. We had to do that with some of the treatment that I received and it didn't take long to get reimbursed since it was a legitimate treatment, it just wasn't exactly normal but neither were the circumstances (this is actually pretty common if you want something that is outside of your plan and is the procedure for doing so should be clearly outlined in your plan, it usually takes less than two weeks for approval to be made). Additionally if they are so convinced that Cigna is in the wrong here then they should have paid and filed a lawsuit against Cigna to force them to cover the treatment.

I know it is harsh to say but these people are responsible for their daughter's care, not Cigna, Cigna is just there to cover some of the payments, but only for payments that are covered under their plan. Just like if I needed a Brand X drug but I had a plan that only covers generics then well it sucks to be me but the company is not at fault, they have other plans that do cover additional treatments and I know that there are insurance plans that cover doctor recommended experimental procedures (not sure if Cigna has them or not), those plans just cost more so you have to decide if it is worth it.




Note: I am not saying that they current health insurance system doesn't have flaws, it has some pretty massive ones, but one can hardly accuse an insurance company of wrongdoing is they are covering everything that is in the person's plan.

[HavelockV]

For the sake of having a talking point rather than a slew of expletives against this and that party to the healthcare debate in America, I would simply like to ask if anyone could explain to me how a country with a nationalized healthcare program would have handled this particular situation.

Would the government have funded the expense of such specialized treatments as bone marrow and liver transplants, particularly since the latter is considered to be an 'experimental' procedure in regards to the treatment of cancer? Also, would this have been accomplished in a more timely manner than CIGNA's eventual decision to allow coverage of Nataline's liver transplant?

Ms. Solumina, I am glad that you posted as you did. I, too, thought that despite the tragic nature of this young girl's illness and death, it seemed there was nothing in her family's insurance policy with CIGNA that suggested the company was required to cover the procedure in question. Furthermore, CIGNA was taking a great risk by granting an exemption in this "rare and unusual case" because if the procedure had been performed in time to save Nataline's life, it would have opened the doors to other policy holders, whose coverage plans also do not include experimental procedures, asking why they, too, could not be considered as exemptions due to "rare and unusual" circumstances as well.

And lest I be labeled as a "Nazi brown shirt" or a disciple of Rush Limbaugh, I will state here and now that I personally have not yet done enough investigation of the issue to have completely made up my mind. I am merely thinking aloud and asking for constructive imput.

Regards.

[Tam Li Hua]

I have to agree with Solumina and Havelock on this one. It's harsh, and I feel for the family, but it's not the insurance company's fault.

It sounds as if the family was in denial of just how sick that poor child was, and is having an extremely hard time dealing with it. [Though I don't know if taking one's grief out on Cigna is really the best course of action..]

As for government health care, I am also not entirely sure that things would have been hunky-dory if the government had stepped in; with the way things are looking, I'm a little afraid of what exactly national health care for us Americans is going to look like. When asked if he would use it himself, Prez Obama sputtered and stammered and never gave an answer. :/

I hope that Blue Cross Blue Shield, Cigna, and all the rest are still around to choose from if and when this government health care thing comes into being. I rather like my BCBS insurance, to be honest....

[CptSternn]

Originally Posted by Solumina

We were on Cigna for a while, my mom did get very sick, we never had a single problem getting them to cover her treatments. The thing is that they lay out what they will and will not cover, there are other things that can happen and they will take that into consideration but it takes time for them to approve such things.

You say you *never* had a problem, but in the same breath say they lay out what they will pay for and what they will not. You then say other things took time for consideration. That contradicts the idea that you never had a problem.

If I have a problem here in Ireland, or anywhere else in the EU, I go to the doctor. If the doctor says I need a test or treatment, I get it. No board supervising costs has to approve anything. Also, there is nothing that they do not cover except elective surgery - like plastic surgery/nose jobs and what not.

I hate to say it but what the family needed to do is suck it up and pay for the procedure (or set up a payment plan with the hospital if they could not afford it, which is likely as transplants are quite costly) and then have Cigna reimburse them after approval for an exception is made.

Except Cigna refused to pay for it three times, there was no approval. And also how easy it is for you to say 'suck it up and pay for it' when the procedure costs upwards of $80,000. I don't know many people who have an extra $80,000 lying around. Do you really think they had the money, but choose to let their daughter die because they wanted to save a buck?

Additionally if they are so convinced that Cigna is in the wrong here then they should have paid and filed a lawsuit against Cigna to force them to cover the treatment.

They did. Now its a wrongful death suit. Either way if she had socialised healthcare, this never would have happened.

I know it is harsh to say but these people are responsible for their daughter's care, not Cigna, Cigna is just there to cover some of the payments, but only for payments that are covered under their plan.

Really? Tell that to the her family, who paid for years to the insurance company who in the end let their child die because they wanted to save their bottom line.

The problem is when you have a company that is all about making profits at some point they will have to let people die, or say sick, so they can make a buck.

There is something very wrong with that.

Just like if I needed a Brand X drug but I had a plan that only covers generics then well it sucks to be me but the company is not at fault, they have other plans that do cover additional treatments and I know that there are insurance plans that cover doctor recommended experimental procedures (not sure if Cigna has them or not), those plans just cost more so you have to decide if it is worth it.

Again, your assuming they had the money to afford all of that extra coverage and what not. IT must be nice to have so much money that you assume the rest of the world lets their kids die because they are cheap.

[Tam Li Hua]

Originally Posted by CptSternn

If I have a problem here in Ireland, or anywhere else in the EU, I go to the doctor. If the doctor says I need a test or treatment, I get it. No board supervising costs has to approve anything. Also, there is nothing that they do not cover except elective surgery - like plastic surgery/nose jobs and what not.

While that may be true for Ireland, how can you be sure that an American national health coverage plan would do the same thing..? I'm not sure I like the idea of my government taking control of my health care, simply because I'm not sure they are capable of doing it well.

Except Cigna refused to pay for it three times, there was no approval. And also how easy it is for you to say 'suck it up and pay for it' when the procedure costs upwards of $80,000. I don't know many people who have an extra $80,000 lying around. Do you really think they had the money, but choose to let their daughter die because they wanted to save a buck?

Wasn't this already answered..? The family could have made a payment plan with the hospital, or filed for a claim later, or done a jillion other things to be able to let this child have the surgery; they didn't have to come up with all the money at once right then.

And Cigna already gave their reasons for refusing treatment; they did nothing illegal or untoward by denying insurance.

They did. Now its a wrongful death suit. Either way if she had socialised healthcare, this never would have happened.

I still don't know about that. Sure, this wouldn't have happened in Ireland, but I don't know that it wouldn't have still happened in the States even with National Health Care.

Really? Tell that to the her family, who paid for years to the insurance company who in the end let their child die because they wanted to save their bottom line.

The insurance company clearly laid out what they do and do not cover before the parents signed an agreement to pay them. It is not the insurance company's fault that the little girl died. No offense, but since she was pretty sick anyways, I have my doubt that -anything- would have saved her at that point..

The problem is when you have a company that is all about making profits at some point they will have to let people die, or say sick, so they can make a buck.

There is something very wrong with that.

But, there are alternatives to paying for it besides just using insurance companies...

Again, your assuming they had the money to afford all of that extra coverage and what not. IT must be nice to have so much money that you assume the rest of the world lets their kids die because they are cheap.

I honestly don't think you're being very fair or reasonable; no one said anything about the family having to pay it all at that moment, or that there weren't other possible ways of funding it. Yes, it's a lot of debt, but many Americans have twice or three times that amount of debt just on their credit cards, but are still able to get the things they need to live...and live well.

One can have tremendous debt and still be able to afford the necessities. It's not ideal, but it's something Americans do every single day.

[Underwater Ophelia]

You guys.
Insurance isn't a fucking charity, it's a business.

They don't even try to hide that fact. If you don't like it, don't get insurance.

[Red Menace]

Originally Posted by HavelockV

For the sake of having a talking point rather than a slew of expletives against this and that party to the healthcare debate in America, I would simply like to ask if anyone could explain to me how a country with a nationalized healthcare program would have handled this particular situation.

I'm in the UK; we have nationalised healthcare. I'm not in the health professions, so this is a layperson's view, but our doctors have budgets and limited resources, including most crucially limited donor organs. The decision would have to be one that balanced not only money but the likelihood of success and the possibility that another person on the waiting list would be a better candidate to receive the organ.

It's certainly not true to say, "if healthcare was nationalised she would have got the surgery and lived" - but by the sounds of it, she may have died even if she had the transplant.

[Solumina]

Originally Posted by CptSternn

You say you *never* had a problem, but in the same breath say they lay out what they will pay for and what they will not. You then say other things took time for consideration. That contradicts the idea that you never had a problem.

We never had a problem getting them to pay for anything. There were certain treatments which were outside of our plan that we initially had to pay for ourselves but we followed Cigna's approval process for treatments outside of one's plan and they reimbursed us before the credit card statements had even come in, to me this is not a problem and in fact is rather nice of Cigna as it is not something that they had to do and they could have just as easily denied the claim.

Originally Posted by CptSternn

If I have a problem here in Ireland, or anywhere else in the EU, I go to the doctor. If the doctor says I need a test or treatment, I get it. No board supervising costs has to approve anything. Also, there is nothing that they do not cover except elective surgery - like plastic surgery/nose jobs and what not.

You have a different system, that's great and I envy that system but that doesn't mean that Cigna acted wrongly here, they covered everything in her plan and I doubt that even in your country a person in a vegetative state would have received an organ transplant when the procedure itself is not a known working treatment but an experimental one. If it was a standard liver transplant then it would have been covered, just like her bone marrow transplant was.

Originally Posted by CptSternn

Except Cigna refused to pay for it three times, there was no approval. And also how easy it is for you to say 'suck it up and pay for it' when the procedure costs upwards of $80,000. I don't know many people who have an extra $80,000 lying around. Do you really think they had the money, but choose to let their daughter die because they wanted to save a buck?

What it reads like to me is that they essentially told Cigna that the doctor said she needed it and that isn't how you go about applying for an exception, you need to get input from additional doctors and you need to be able to show that she has a good chance of benefiting from the procedure, a person in a vegetative state doesn't have a very good chance of surviving the surgery, let along recovering from the complication of the previous treatment that put her in that state.

I'm not saying that they need to pay all of the money at once, you can set up a payment plan with the hospital, take out a health care loan, and/or access whatever credit you have, it does suck but sometimes you have to do shit that sucks, after all a bunch of debt is worth being able to keep your daughter alive. Oh and Cigna did eventually approve the treatment, it was just too late for it to be a viable option, if the parents had done something to make the treatment happen then they would have been reimbursed.

Originally Posted by CptSternn

They did. Now its a wrongful death suit. Either way if she had socialised healthcare, this never would have happened.

They filed a suit but they didn't do anything to get their daughter the care they thought could save her life. Win or lose their daughter is dead, if they had taken the debt upon themselves they would be fighting to get reimbursed, not compensated for her death.

Originally Posted by CptSternn

Really? Tell that to the her family, who paid for years to the insurance company who in the end let their child die because they wanted to save their bottom line.

I'm not saying that it doesn't suck but in the end their child died because her experimental procedure wasn't covered under their plan. Cigna didn't let her die, if they just wanted the money they wouldn't have covered her bone marrow transplant, they did everything that they should have done.

Originally Posted by CptSternn

The problem is when you have a company that is all about making profits at some point they will have to let people die, or say sick, so they can make a buck.

There is something very wrong with that.

There is something wrong with that but it isn't the insurance companies fault, if it wasn't for Cigna she never would have had her first transplant.

Originally Posted by CptSternn

Again, your assuming they had the money to afford all of that extra coverage and what not. IT must be nice to have so much money that you assume the rest of the world lets their kids die because they are cheap.

Well where do you want the money for the surgery to come from? Cigna has a responsibility to its employees as well as its other policy holder to stay in business and they are not responsible for going above and beyond what is in someone's plan, which they did cover.

If you want to be mad at anyone be mad at the hospital for not approving the procedure before payment was secured. If the procedure had been approved then the family would have taken a huge hit to their credit, possibly even have to file for bankruptcy but she would be alive.

[Saya]

What it reads like to me is that they essentially told Cigna that the doctor said she needed it and that isn't how you go about applying for an exception, you need to get input from additional doctors and you need to be able to show that she has a good chance of benefiting from the procedure, a person in a vegetative state doesn't have a very good chance of surviving the surgery, let along recovering from the complication of the previous treatment that put her in that state.

It was backed by four UCLA doctors.

I'm not saying that they need to pay all of the money at once, you can set up a payment plan with the hospital, take out a health care loan, and/or access whatever credit you have, it does suck but sometimes you have to do shit that sucks, after all a bunch of debt is worth being able to keep your daughter alive. Oh and Cigna did eventually approve the treatment, it was just too late for it to be a viable option, if the parents had done something to make the treatment happen then they would have been reimbursed.

They needed to make a $75000 down payment which they understandably didn't have.

I'm not saying that it doesn't suck but in the end their child died because her experimental procedure wasn't covered under their plan. Cigna didn't let her die, if they just wanted the money they wouldn't have covered her bone marrow transplant, they did everything that they should have done.

"Sarkisyan's four UCLA doctors immediately wrote back to Cigna, appealing the decision. They argued Sarkisyan would have a 65% chance of surviving for six months after the liver transplant, based on studies of similar patients. The doctors reckoned Sarkisyan had an 85% chance of avoiding a recurrence of cancer because of the successful bone marrow transplant."

http://www.forbes.com/2008/01/08/sar...0107cigna.html

So not quite so experimental.

However I do agree that the hospital administration is just at much to blame if not more for not saving her life anyway and worry about appeals or money later. She sadly was caught up in a system that doesn't work.

[Solumina]

The link you posted just sent me to Forbes website but not an article. I'm not going to comment on specifics as I don't know them but I have seen different numbers thrown about in different publications.


If they needed that down payment then that is the hospital's fault, it should in no way have been near that high unless the family could pay. Down payments for hospital approved payment plans are made according to the resources available to the patient, or in this case the patient's parents. If that is the required down payment then there is a serious problem with that hospital's administration, especially since that "down payment" seems to be the approximate cost of the procedure.

[Saya]

Weird, just copy and paste the quote I used into google and you'll be able to see it that way.

"If they needed that down payment then that is the hospital's fault, it should in no way have been near that high unless the family could pay. Down payments for hospital approved payment plans are made according to the resources available to the patient, or in this case the patient's parents. If that is the required down payment then there is a serious problem with that hospital's administration, especially since that "down payment" seems to be the approximate cost of the procedure."

I didn't get that either but I figured that it counted after care, which can cost up to $450, 000. They couldn't just slap a liver in her and then not take a lot of care to ensure it worked.

[Pineapple_Juice]

Just a question: how is a liver transplant an "experimental, investigational and unproven service"?

[Solumina]

Because it was being used to treat a complication from a bone marrow transplant, if it was being used because you have cancer in you liver and it had to be removed, or some other such scenario, then a liver transplant would have been standard procedure and would have been fine.

Note I retract my use of the word experimental it should have been an investigation or unproven service but those fall under the same category as experimental treatment and I was being lazy and didn't differentiate.