While browsing through the news headlines today, I came across a story about a 17-year-old girl who passed away from liver failure. Nataline Sarkisyan's liver was malfunctioning due to a rare complication she had from a bone marrow transplant. She needed the bone marrow to survive her on-going battle against leukemia.
The complications from the transplant were so severe, her liver and kidneys were completely damaged. In order to stay alive she needed a new liver immediately. But her health insurance company, Cigna, refused to pay for the organ transplant.
As an excuse for why Cigna denied coverage, the company claimed they do not pay for "experimental surgeries." But Nataline's family fought back and demanded Cigna cover the operation. As soon as the insurance company agreed to pay, Nataline died. Her family is left feeling as though her life was unnecessarily snatched away from her.
Stories like this always hit hard. But in my case, Nataline's death hit harder since I personally knew her for years. We went to the same dance studio, where I watched her grow up, dance, and goof-off in class. When I read the news of her death today, a million negative feelings bombard me at the same time. But one emotion that conquers all is anger.
Nataline was a girl who never had the opportunity to experience a single day of college, or see what it's like to live her dream as a fashion designer. An insurance company determined Nataline's fate, and it's scary to think a nameless, faceless person has the ability to decide whether a person lives or dies.
Nataline's story is just one example of the problems faces with health care. Money comes before saving a person's life, and it is an issue the government obviously does not pay enough attention to. Why pay for health insurance if the company will not cover a life-saving operation? That's the question Nataline's family is asking today.
The family plans to sue Cigna for her death. But I imagine no amount of money could ever relieve the anguish they feel.
Reader Comments ( Page 2 of 3)
16. 17 is a young age to face such medical hardships. However the facts are this... she was very sick, the family was grasping at straws and willing to try anything to save a loved one. I don't blame them. The insurer made a decision based NOT on emotion but on medical statistics. No one will ever know if it WOULD have worked... Only what the ODDS were. In this case they were very low.... so as an insurer you ask yourself... "Is this a good prudent use of limited resources?" That million dollar transplant could have fixed thousands of broken arms... paying that claim may have raised the rates just enough for hundreds of families to no longer afford their insurance. IS that better? Some of you would like goverment controlled heatlh care... Try to SUE them when you don't get your way... Quite frankly, when its your time.. its your time... she recieved a transplant already.. and I am sure quite a bit of medical care PAID for by CIGNA... so ask yourself... should that liver have gone to her.. or some other child that had a great chance? No one can play GOD and whoever does have to make these decisions I feel sorry for... all of you uneducated persons who reflect your rage by saying "burn in hell greedy &*^%" really don't have a grasp on the dynamics here. I wonder what they would do if it REALLY were their decision and they knew the REAL facts....
mark at 10:34AM on Dec 22nd 2007
17. There is no room between a doctor and patient for an insurance company that, by law, must make a profit by denying and refusing procedures.
Mac at 10:55AM on Dec 22nd 2007
18. Greed and our own apathy killed this child.
The good Dentist is spot on, our healthcare model IS NOT WORKING! One out of every seven people in America are uninsured. This story is proof that those who have insurance are not safe either. Even with insurance, your health is not "insured."
Here is what is insured under the current system:
* Health Insurance company stocks pay dividends.
* Drug company stocks pay dividends
* Medical equipment company stocks pay dividends.
* Doctors and Lawyers have very high incomes,2nd and 3rd homes, 2 or 3 high end luxury cars and country club memberships.
* Financial ruin if you get a life threating illness.
* Your wealth can determine if you live or die.
* Poor people don't stand a fighting chance.
American Citizens need to take control of our healthcare sytem and make it work to provide recovery from illness, not a good return on our stock purchase or bragging rights of a Benz and country club membership.
This innocent child should not have had to pay with her life because we as citizens, who control the power of this representational republic with our vote, do not have the fortitude and courage to say enough is enough to the politicians who accept the corrupting influence of lobbiests at our expense.
Health should be a constitutional right. Provided for all by all. Our taxes (TRILLIONS) are being used to play international policeman, why then can we not see fit to use them to help your sick neighbor's child, mother or even you someday?
We as citizens have the unalienable right to LIFE, liberty and the pursuit of happiness, that is, until you get sick, then, if your not wealthy enough to pay to get well, you die. So much for that right to life!
Shame on us all for allowing this to be.
Shame on us for being behind France, Great Britian, Canada, Norway, Sweden and even Cuba when it comes to treating the sick.
How have we allowed this to happen?
To the family in this story, I'm sorry for your loss.
P G at 11:15AM on Dec 22nd 2007
19. Mark... here is the point. The money for the transplant isn't going to fix broken arms. It's going to fatten profit margins.
Now I have no quarrel with capitalism or profit, I could use a bit more of it in my own life. But there are some things in which profit should never come first, and first and formost is health. It is, one might say, the axle around which everything must turn. If I am not healthy then I am unable to work. I am unable to pay my bills. I am unable to provide for my family. I am unable to pay into the system that supports my country. In short I can not be a productive and contributing member of society as I know how without my health. It is the responsibility of myself and my doctor to keep me healthy and it is the obligation for my insurance agency to pay for it. I pay a 1700 dollar a year personal policy, as my partner's insurance won't cover a "life partner" (but that's another rant). From that 1700 dollar policy I must pay 1500 before they will pay a dime. Like I said. It's car wreck insurance.
And oh... yes... lawsuits. Oh the poor insurance companies... always getting sued! They have to keep their profit margins through the roof or they'll lose it all to those greedy lawyers!
Bullshit. The vast perponderance of claims denied are never challenged in court. Of those that are, far far more are dropped. Why? The insurance company can bring far more massive legal cannons to bear than individual people. And those that don't drop? They usually settle... for the amount they would have paid to do the proceedure. In short, the insurance companies have absolutely little to lose and everything to gain by denying claims. And those rare rare cases where a plantive actually... gasp... get awarded punative damages? Those millions are a blip in profit margins that reach billions.
So. Again. I ask the question... rather I demand it... how would these people who support these health insurers suggest they change their actions if they can not be sued into compliance? Congress and the Whitehouse for DAMNED sure isn't doing to do anything to them. The normal market doesn't apply here because going to a different MHC is no different from any other. They're all profit centric. There's only ONE non-profit insurance agency: medicare.
So... if we can't sue them into changing, then what do you suggest we do?
Somber at 11:16AM on Dec 22nd 2007
20. "These are decisions that should be made by the health care team not a very wealthly MBA."
Decisions are made by health care professionals. The wife of a former co-worker is a nurse and works for Blue Cross/Blue Shield, evaluating when patients when patients should be discharged from the hospital.
My primary-care physician is a consultant with an insurance company. He evaluates what should be normal courses of treatments for various illnesses. His job isn't to deny care for patients, but rather, to keep doctors from overcharging.
And trust me doctors do overcharge, or try to. When my wife and I went through infertility, the specialist said we had 0 chance of getting pregnant without going through full-blown invetro, which meant numerous trips to his office and a hospital that was some distance away. We decided to go for adoption.
Then guess what? My wife had a miscarriage. So we went to another specialist that all but said that the first specialist was too pessimistic about trying less intensive forms of treatment.
Finally, you also have to remember that insurance companies are limited by what employers will pay under their health plans. My wife's employer used to pay for gastric by-pass, based on the assumption that a certain number of employees and dependents would undergo the procedure in a given year. When the number of patients was about 6 times what the carrier anticipated, gastric by-pass was removed from the list of covered procedures.
Again, doctors were recommending the procedure for patients who may have been very overweight and unable to lose weight through diet and or exercise, but they weren't morbidly obese. Gastric by-pass is for people who need to lose 100 pounds or more, and not just 40 pounds.
Unfortunately, some doctors are like auto mechanics who can find several hundred dollars worth of repairs, when the car comes in for an oil change.
Kent at 11:24AM on Dec 22nd 2007
21. I feel terrible for the girl and her family. I should also say that I am not a fan of insurance companies, but, this is really a case of sensationalizing a 2 bit story. If you read detailed articles, you will see that the medical data shows that Nataline had a 65% chance of adding 6 months to her life with the surgery. It would not have saved her. In fact, the required medications for undergoing a transplant aggressively feed the cancer, which would have hastened her death anyway. I can't imagine the anguish that Nataline's family must be feeling. But, this really is just misplaced anger towards Cigna.
Kagan at 11:41AM on Dec 22nd 2007
22. #14 Enoch says: "the better health care they provide,the less profit they gain,which in turn hurts their shareholder's and future's.
the more care they deny,they better off their shareholder's are,and better off on the trading floor."
Well, once again, 'enoch the magnificent' has got things bass akwards.
Working in ophthalmology, with a specialty in retina, our practice sees a multitude of patients with systemic medical problems such as diabetes.
Often times, the patient tells us that they were being referred/directed by their insurance company (HMO included) to get a checkup to look for associated conditions that may be a byproduct of their disease, such as retinopathy of glaucoma.
Insurance companies encourage preventative maitenance which is beneficial for cost containment and the well being of the patient. A win-win situation.
You'd also be amazed at how many of these patients walk (waddle) through our doors, strapped to an oxygen cylinder, a pack of Marlboro's in front pocket, and make our exam chair disappear after sitting on it.
lizard at 11:33AM on Dec 22nd 2007
23. Wake up you morons, the real issue here are those 535 useless pieces of walking excrament called Congressmen who have head to toe medical coverage funded by your back pocket. They have designed a program that provides the highest quality, cost is no object, health care for themselves at your expense. You pay for 72% of the premium.
Is this a Government of the Politician? Do you work for them? Call your Senators and Federal Representative and ask why they use the FEHB at your expense!!! Demand that they buy their own medical coverage as you have to do!!!!!!!
Paul Sparcello at 12:10PM on Dec 22nd 2007
24. Second post for me on this subject. It is a subject that is close to my heart. Most everybody that has posted is right - the system is not perfect. Insurance companies are in it to make money - but so are doctors and hospitals. At some point in the line of checks and balances, somebody ultimately has to let common sense and realistic prognosis prevail over heart-rending emotion. Just a bone marrow transplant costs upwards of $1m and has itself a very unpredictable outcome. What if, in this case, the doctors were persuaded by an overwrought family into making this liver transplant request, knowing that a positive outcome was virtually non-existent. A decision based on, as previously mentioned, a "cover our a-- to keep from being sued" mentality. "Let's be the good guys and let the insurance company take the hit on this one". Who here can say for sure that didn't happen? From what I have read about this case, the statistical expectation for this procedure was a 65% chance of survival for 6 months. And that would have been six months of extreme illness and hardship on both the patient and the patient's family, if it had even lasted that long. Do you people realize that a BMT patient, for about a month after the transplant, has no bone marrow? And with no bone marrow, their blood doesn't clot. No brusing of teeth or clipping of nails, because they could bleed to death. They are on such high dose steroids that their bones become brittle and in some cases actually die. They have constant, extreme diaherrea, urinate blood, have no appetite, and no immunity. Been there, done that, got that t-shirt. Almost any patient can be kept alive indefinitely on life support - what is the realistic limit here? There is almost always another medical test or procedure that can be "tried" - what is this limit? At some point along the way, someone in the chain authority, whether it is the doctor or the insurance company or the organ donor bank, has to step in and say it's time to stop and accept the inevitable. "We've done everything we can within REASONABLE limits". If, when my grandson suffered from exactly the same condition that this girl suffered from, his doctors had suggested a liver or kidney transplant, I would have probably given them the go-ahead because both myself and the rest of my family were desperate. But I'm so thankful that they were conscientious enough not to suggest that because with 20/20 hindsight, I know that with any more burden on his already beat-to-a-pulp young body, he would not be alive today. Again, I will state that I fault the team of physicians, likely for their own legal protection, for misleading this family into believing the liver transplant might even remotely be the answer. And I applaud the insurance company, probably for the first and only time, for putting a halt to a no-win situation for everyone concerned.
Millie at 12:12PM on Dec 22nd 2007
25. Let's address this latest trifecta.
Kent, pushing blame on the other side of the fence. It's the doctors overcharging. They're the reason why the insurance company just has to say no. No, won't pay a single damn cent. The doctors are just asking too much. By the by, don't mind us and our record profits. It's not like, if the doctors are really asking too much, we could offer a maximum amount and then expect the patient to pick of the tab. No, we couldn't do that because then we'd actually be paying something.
And lizard. Blaming the other side of the equasion. It's those damned fat smoking bastards that make things just too damned expensive. Well last I checked, if you were overweight, you paid more. If you smoked. You paid a hell of a lot more. If you drank. You paid more. And then the insurance company will deny you anyway. So tell me what dietary recommandations would you make for some one coming down with... say... Lieukemia? Or breast cancer? Or ALS. So the people who are fat, smoke, and drink are all ready paying higher primiums than those who don't and meanwhile those with conditions that are unpreventable are denied anyway.
And Kagan... how much is six months of your life worth to you and your family? Name a number. How about your life in general? What's the dollar amount point where it's okay for you to die? Or for your child to die?
Here is the other sickening thing. America is the only industrialized nation in which this occurs. It is the only one. The. Only. One. Don't you get it? We're a third world nation of medical care. At least other third world nations have an excuse, they're poor. But we're at the moment still the richest country in the world and yet we have people die of treatable conditions because of profit margins. Do you get it? You are putting a stack of printed paper above a living, feeling, flesh and blood person. You are arguing that that paper is more important than that individual. Is that really how callous and shallow our civilization has become? Where we allow children to die because that paper means more than their life? Four doctors begged for the proceedure, to give her six months at least. At least. And yes, it could have failed, and it would have been just as tragic, but we could have said "At least we tried to give her more life. At least we made the attempt. At least we put money as secondary and gave her a chance to go on and say her farewells."
But no. No attempt was made. It was denied. And denied. And denied and denied and finally, only finally, hours too late, did a crack of decently shown through.
Somber at 12:24PM on Dec 22nd 2007
26. Let's address this latest trifecta.
Kent, pushing blame on the other side of the fence. It's the doctors overcharging. They're the reason why the insurance company just has to say no. No, won't pay a single damn cent. The doctors are just asking too much. By the by, don't mind us and our record profits. It's not like, if the doctors are really asking too much, we could offer a maximum amount and then expect the patient to pick of the tab. No, we couldn't do that because then we'd actually be paying something.
And lizard. Blaming the other side of the equasion. It's those damned fat smoking bastards that make things just too damned expensive. Well last I checked, if you were overweight, you paid more. If you smoked. You paid a hell of a lot more. If you drank. You paid more. And then the insurance company will deny you anyway. So tell me what dietary recommandations would you make for some one coming down with... say... Lieukemia? Or breast cancer? Or ALS. So the people who are fat, smoke, and drink are all ready paying higher primiums than those who don't and meanwhile those with conditions that are unpreventable are denied anyway.
And Kagan... how much is six months of your life worth to you and your family? Name a number. How about your life in general? What's the dollar amount point where it's okay for you to die? Or for your child to die?
Here is the other sickening thing. America is the only industrialized nation in which this occurs. It is the only one. The. Only. One. Don't you get it? We're a third world nation of medical care. At least other third world nations have an excuse, they're poor. But we're at the moment still the richest country in the world and yet we have people die of treatable conditions because of profit margins. Do you get it? You are putting a stack of printed paper above a living, feeling, flesh and blood person. You are arguing that that paper is more important than that individual. Is that really how callous and shallow our civilization has become? Where we allow children to die because that paper means more than their life? Four doctors begged for the proceedure, to give her six months at least. At least. And yes, it could have failed, and it would have been just as tragic, but we could have said "At least we tried to give her more life. At least we made the attempt. At least we put money as secondary and gave her a chance to go on and say her farewells."
But no. No attempt was made. It was denied. And denied. And denied and denied and finally, only finally, hours too late, did a crack of decently shown through.
Somber at 12:24PM on Dec 22nd 2007
27. The dirty little secret that isn't being mentioned in all of this, is that the physicians didn't have to wait for insurance approval in order to do this transplantation. If they were so confident that it would've worked, then they have an ethical, moral obligation to proceed. All it would have "costed" them would have been some personal time, and the hospital would've donated the disposable supplies needed if there had been some passionate persuasion from the physicians in charge of her care. The surgeons could have fought for reimbursement later.
We've 'advocated' in this manner before for some of our patients. Interesting how her physician's were right by her side while the money was flowing for bone marrow transplant, chemotherapy, etc., then abandon her when there was a question about the efficacy of a procedure. As harsh as this may sound, as far as I'm concerned, the people who should be sued, are the physicians who suggested the false hope of this procedure. Also, not noted in TYT post was the fact that this patient was in a vegetative state for three weeks prior to Cigna approving funds for the transplant. Probability of survival: Zero percent.
Physicians making an 11th hour money grab on a "warm body" terminal patient, resulting in hundreds of thousands of dollars, plus a perfectly good liver going into the ground based upon greed and emotions, are some of the biggest problems in rising health care costs, along with the ambulance chasing John Edwards, Mark Geragos-type lawyers.
lizard at 12:32PM on Dec 22nd 2007
28. I hope all of you saddened and angered by this life being cut short are as strongly opposed to abortion.
More children are slaughtered in abortion clinics each day than died when the twin towers fell.
Here's hoping you think.
mick at 1:07PM on Dec 22nd 2007
29. Here is what I think. When you are outside another person's body then you are a person. Until then it's a tumor, and a terminal one if not eventually removed from the host. Once it is out side the body, capable of life independant of another person's biology, then it can have the full legal protection any and all humans are entitled to.
Until then, it's meat.
Somber at 2:08PM on Dec 22nd 2007
30. #25 Somber. We know that you're a man hater, but why don't you cut up Millie's post #24? She speaks of compassion and logic, and in the end sides with logic-- a trait that seems to be like kryptonite to you. In this case, your appeal of, "At least we tried to give her more life," has the same logic as trying to justify purchasing the highest quality brake pads to place on a car that has just been 'totaled' by a speeding train.
lizard at 2:41PM on Dec 22nd 2007