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Teenager Dies After Insurance Company Balks at Transplant

Posted by Steve Benen, The Carpetbagger Report at 7:03 AM on December 22, 2007.


Obviously, as a matter of humanity, one's heart has to go out to the Sarkisyan family, whose pain has to be unimaginable right now.
The Case of Nataline Sarkisyan

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Sometimes, the national healthcare scandal isn't limited to those without insurance; sometimes it's equally outrageous what happens to those with insurance. (thanks to LM for the tip)

The family of a 17-year-old girl who died hours after her health insurer reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday.

Nataline Sarkisyan died Thursday at about 6 p.m. at the University of California, Los Angeles Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.

Attorney Mark Geragos said he plans to ask the district attorney to press murder or manslaughter charges against Cigna HealthCare in the case. The insurer "maliciously killed her" because it did not want to bear the expense of her transplant and aftercare, Geragos said.

Nataline was battling leukemia -- she had received a bone marrow transplant from her brother -- but experienced liver failure as a complication from the treatment. Gigna reportedly balked at the cost of the transplant, calling the procedure "experimental" and outside the scope of coverage.

In the wake of the decision, 150 students and nurses protested at the company's offices. Cigna, apparently afraid of a public-relations nightmare, reversed course and said it would pay for the liver transplant.

But it was too late. Nataline died within hours of Cigna changing its mind about the procedure.

"They took my daughter away from me," said Nataline's father, Krikor, who appeared at the news conference with his 21-year-old son, Bedros.

Despite the reversal, Cigna said in an e-mail statement before she died that there was a lack of medical evidence showing the procedure would work in Nataline's case.

"Our hearts go out to Nataline and her family, as they endure this terrible ordeal," the company said. "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."

Nataline's doctors at UCLA estimated that she had a "six-month survival rate of about 65 percent." Apparently, that was all Cigna had to hear before denying the claim.

Obviously, as a matter of humanity, one's heart has to go out to the Sarkisyan family, whose pain has to be unimaginable right now.

But as a matter of politics, one also has to wonder whether a tragedy like this one might have an impact on the healthcare debate. It should.

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Tagged as: hmos, health insurance

Steve Benen is a freelance writer/researcher and creator of The Carpetbagger Report. In addition, he is the lead editor of Salon.com's Blog Report, and has been a contributor to Talking Points Memo, Washington Monthly, Crooks & Liars, The American Prospect, and the Guardian.


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View:
Cigna Should Be Very Happy
Posted by: QQOblivion on Dec 22, 2007 6:59 AM   
Current rating: 5    [1 = poor; 5 = excellent]
Cigna should be very happy with themselves now. The girl's death has saved the insurance company a bundle, since they don't now have to do the liver transplant!

[« Reply to this comment] [Post a new comment »] [Rate this comment: 1 - 2 - 3 - 4 - 5]

» RE: Cigna Should Be Very Happy Posted by: Tokyo Tuds
» RE: Cigna Should Be Very Happy Posted by: Tokyo Tuds
Shows the problem with ALL for PROFIT plans
Posted by: JSquercia on Dec 22, 2007 7:56 AM   
Current rating: 5    [1 = poor; 5 = excellent]
This is proof positive that solution to our Health Care crisis is NOT for Profit Insurance . They have as their PRIMARY purpose the well being of their shareholders and NOT their customers .
As is rarely pointed out to the Likes of Rudy Guilliani and John McCain THEY could NOT get
Private Insurance due to their history of cancer . Just once I would like to see THAT FACT brought up .

[« Reply to this comment] [Post a new comment »] [Rate this comment: 1 - 2 - 3 - 4 - 5]

Jean Hay Bright
Posted by: jeanhaybright on Dec 22, 2007 8:22 AM   
Current rating: 5    [1 = poor; 5 = excellent]
This situation would not be an issue under the universal, single-payer, NOT-FOR-PROFIT health care plan, HR 676, proposed by Congressman and Presidential Candidate Dennis Kucinich.

But this article seems to be missing one key point.

"Attorney Mark Geragos said he plans to ask the district attorney to press murder or manslaughter charges against Cigna HealthCare in the case. The insurer "maliciously killed her" because it did not want to bear the expense of her transplant and aftercare, Geragos said."

Is the insurer the problem here, or the hospital, which apparently refused to perform the operation until it could be guaranteed payment? Why didn't the hospital do the transplant, and then argue with the insurance company afterwards over who would pay the bill?

[« Reply to this comment] [Post a new comment »] [Rate this comment: 1 - 2 - 3 - 4 - 5]

The Best thing that happen for my health was that i lost my health insurance!!
Posted by: Life48 on Dec 22, 2007 1:57 PM   
Current rating: 5    [1 = poor; 5 = excellent]
But, unfortunately, if you need emergency care or care like this teenager needed then you are screwed even if you have health insurance in the United Snakes!

[« Reply to this comment] [Post a new comment »] [Rate this comment: 1 - 2 - 3 - 4 - 5]

I hope the family sues big time.
Posted by: weslen1 on Dec 22, 2007 2:28 PM   
Current rating: 5    [1 = poor; 5 = excellent]
This is why we need to get insurance companies OUT of health care. And we need to separate Medicaid from welfare, and make it easier to get. Several years ago a friend of my sister's applied for disability because she had developed heart disease. She needed a bypass. She was given the run around for more than 6 months before she was finally approved. The letter came one day after she had a massive heart attack and died. I waited nearly a year and had to be hospitalized and recovering from surgery before being approved. None of my medical bills were covered and last year, 3 days before Christmas I had to go to court because one of the doctors was suing me. And I've got to say that I am totally sick of hearing these holier than thou, God fearing paragons of virtue in congress, mostly in the Republican party saying that because I was not born with a silver spoon in my mouth, living my life on the sweat of others, like the Bush sons that my life should be forfeited as worthless.

[« Reply to this comment] [Post a new comment »] [Rate this comment: 1 - 2 - 3 - 4 - 5]

It's Time For Universal Coverage.
Posted by: liblady2008 on Dec 22, 2007 3:39 PM   
Current rating: 5    [1 = poor; 5 = excellent]
There is no reason not to do it - if we had it now this girl(and countless people like her) would still be alive.

It's a disgrace we have lagged behind the rest of the civilized nations in getting this done.

Getting quality health care should not depend on how much money you might or might not have.

Funding? Just rollback the tax cuts for the obscenely wealthy and quit throwing away billions on an unnecessary war we were lied into.

[« Reply to this comment] [Post a new comment »] [Rate this comment: 1 - 2 - 3 - 4 - 5]

So What?
Posted by: LeaveMeAlone on Dec 22, 2007 6:06 PM   
Current rating: 4    [1 = poor; 5 = excellent]
The choice is this: Provide proper care to thousands or deny the claims of thousands so the CEO and his closest cronies can pocket each year enough money to provide themeselves and their next ten generations lives of unbelievable splendor. Let'm die.

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Why didn't conservative lawmakers held emergency session to
Posted by: PakiBoy on Dec 22, 2007 6:28 PM   
Current rating: 4    [1 = poor; 5 = excellent]
pass law prohibiting CIGNA from denying this girl's 'right to life' as they did in Terri Shiavo case?

amerikans are damn effing stupid. If you don't believe me just look at the popularity of Huckabee!

[« Reply to this comment] [Post a new comment »] [Rate this comment: 1 - 2 - 3 - 4 - 5]

Really?
Posted by: dnyu on Dec 23, 2007 5:16 AM   
Current rating: 1    [1 = poor; 5 = excellent]
Sounds to me like her leukemia killed her. Regardless of the payment system, we cannot act as though there are unlimited resources for any and all treatments. With all due respect to the family here, choices like this unavoidable, no matter who is paying.

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» Idiot Posted by: marid
» RE: eally? Posted by: curiousgeezer
if it had been the president or a member of congress
Posted by: nebgirl on Dec 23, 2007 12:26 PM   
Current rating: 5    [1 = poor; 5 = excellent]
do you think any expense would have been spared, no matter how slim the chance of success? no wonder they think our health care system is great.

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Universal Healthcare Coverage
Posted by: Landbaron on Dec 25, 2007 10:56 AM   
Current rating: 1    [1 = poor; 5 = excellent]
All the people against Universal Coverage wear her blood on their hands. Especially the insurance companies and those in charge of making decisions to save them money....Although I've made lots of money from their stocks, I'm just an opportunist chasing the American dream,,,uno,,,get RICH!!!

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The best example of why Insurance companies should be taken completely out of the health care
Posted by: johngary66 on Dec 26, 2007 1:39 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
equation is the case of Dr. Bill McGuire, the former CEO of United Health Care. The following excerpt is from the Associated Press.
JOSHUA FREED,Associated Press
Posted: 2007-12-07 00:18:55
MINNEAPOLIS (AP) - Getting former CEO William McGuire to give back hundreds of millions of dollars in tainted stock options cures one of UnitedHealth's biggest headaches from its backdating scandal. But there are others.

McGuire agreed to a settlement the Securities and Exchange Commission valued at $468 million, including giving back $320 million in stock options. He had already agreed to reprice some stock options, reducing their value by another $200 million.

That and a $7 million civil penalty was enough to get the SEC to settle with him. But the SEC said its investigation of the company is continuing, and a review by the U.S. attorney for the Southern District of New York is also outstanding.

UnitedHealth Group Inc. has been trying to put the matter behind it, adopting numerous governance reforms last year and adding independent directors. Current CEO Stephen Hemsley has apologized for the scandal and agreed last year to reprice or give back $189 million worth of stock options to remove the possibility that he benefited from backdating.

McGuire ran UnitedHealth for 15 years, turning a regional insurer into what is now the nation's second-largest managed care company. Like many other companies in the 1990s, UnitedHealth rewarded its chairman and CEO with options giving him the right to buy UnitedHealth shares at a fixed price. The value of those options skyrocketed along with the company's share price. McGuire's unexercised options were worth more than $1.75 billion at the end of 2005.

McGuire was allowed to choose the dates for his option awards. The crux of the backdating accusation is that, to boost the options' value, he picked a date in the past when the share price was lower and signed papers as if he was granted the options on that earlier date. That hands the recipient an instant profit but needs to be disclosed to avoid accounting - and, potentially, legal - headaches.

The settlement announced Thursday resolves a lawsuit brought by shareholders on behalf of the company, as well as a civil complaint by the SEC. The SEC said McGuire did not admit or deny guilt.

The settlement includes a $7 million civil penalty for the SEC and reimbursement to the Minnetonka-based insurer for all incentive- and equity-based compensation he received from 2003 through 2006, the SEC said.

The agency said it was the largest penalty assessed against a person in an options backdating case. The settlement "reflects the magnitude and scope of Dr. McGuire's misconduct," Linda Chatman Thomsen, director of the SEC's Enforcement Division, said in a statement. End AP Excerpt...................
Other board members also recieved back dated stock options worth over $4 billion. How many people could have had excellent care for just the amount of money the top executives and board members were given? How many people had to be denied care by United Health?

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Premeditated Murder One, special circumstances; Financial Gain
Posted by: Landbaron on Dec 30, 2007 10:46 AM   
Current rating: Not yet rated    [1 = poor; 5 = excellent]
Death Penalty for insurance decision makers...Isn't it time for Universal Healthcare???...But one letter of the alphabet protects these evil decision makers; Did you know not having this transplant 'could've' killed her? Or did you know it 'would've' killed her. In the eyes of the law, a big difference.

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