Friday, December 21, 2007

Murder by Spreadsheet at UCLA

DailyKos blogger nyceve is known for her relentless diaries exposing the corrupt for-profit health care industry. Today, she alerted us to a case at the UCLA Medical Center, where a 17-year-old girl was near death and in need of a liver transplant. However, CIGNA had denied the treatment. What's appalling are the excuses CIGNA threw up to prevent the treatment.

In a Dec. 11 letter to CIGNA's transplant department, four UCLA physicians said that Nataline "currently meets criteria to be listed as Status 1A" for a transplant and urged the company to "urgently re-review her case" and their denial. CIGNA said it denied the care because their benefit plan "does not cover experimental, investigational and unproven services," to which the doctors replied, "Nataline's case is in fact none of the above."

On Dec. 14, Hilda Sarkisyan was told by the hospital that a healthy liver was available, but because CIGNA had refused authorization, the family would have had to make an immediate down payment of $75,000 to proceed, an amount the family could not afford.

What's the point of having insurance if they won't do jack shit when you actually need them? The letter from the UCLA doctors is truly damning, refuting CIGNA's excuses to save money. Well, nyceve wasn't having that, and let the blogosphere know about it.

In a stunning turn around, insurance giant CIGNA has capitulated to community demands, and protests that the California Nurses Association/National Nurses Organizing Committee helped to generate, and agreed to a critically needed liver transplant for Nataline Sarkisyan, a 17-year-old girl in the intensive care unit at UCLA Medical Center.

A national web of friends and family of Nataline, CNA/NNOC registered nurses, doctors, members of the Armenian community, healthcare advocates, and netroots supporters pitched in on an unprecedented national day of action on Nataline’s behalf.

The centerpiece of the protests was an impassioned rally today sponsored by CNA/NNOC with the substantial help of the local Armenian community that drew 150 people to the Glendale offices of CIGNA. Hundreds of phone callers clogged the lines of CIGNA offices around the country, all demanding that CIGNA reverse its prior denial of care.

"This is an incredible turnaround generated by a massive outpouring around the country that proves that an enraged public can make a difference and achieve results," said CNA/NNOC Executive Director Rose Ann DeMoro. "CIGNA had to back down in the face of a mobilized network of patient advocates and healthcare activists who would not take no for an answer."

The netroot protest was organized by Eve Gittelson, an influential health policy blogger who writes on Daily Kos as nyceve, and many of the calls were also the product of work by the Armenian National Committee.

Success!! Or so we thought....

ABC story

WESTWOOD -- A Northridge teenager awaiting a liver transplant died Thursday after she was pulled off of life support.

CIGNA Insurance Company initially refused to cover the cost of the transplant for Natalee Sarkisian, saying the surgery was too experimental.

On Thursday, friends, family and members of a nurses association held a protest outside CIGNA headquarters in Glendale, urging the insurance company to reconsider.

During the protest, Natalee's mother got word CIGNA had changed its mind and would make an exception for Natalee's surgery.

But the decision came too late for Natalee. Just after six o'clock tonight, her condition worsened.

Natalee's family took her off life support and she passed away.

Attorneys for the Sarkisian family may pursue legal action against CIGNA HealthCare.

We're still in shock. Just mere hours after caving in and approving the transplant, the girl dies. For how many weeks and months had CIGNA been dicking around the Sarkisyan family? It's tragically ironic they stonewalled up until hours before she died. So in the end, CIGNA gets to keep their money anyway.

And people still think you can negotiate in good faith with these heartless bastards?


Anonymous said...

I work in health care and have been fighting losing battles with insurance companies for years. They truly are purely profit-driven bastards. I also know for a fact that decisions are made by company officials with profit and bonus check decisions in mind. I was hired to be a clinical director for a company, and I was naive enough to believe that the company cared about quality. Interestingly, one of the big issues discussed was year-end bonus checks, which were, of course, based on reducing expenditures for health care. Managed care does not save anyone money, it just shifts the money to managers and administrators. It is time for national health care! Health care should not be under private, for-profit control!

Anonymous said...

How come no one is blaming UCLA? A doctor's commitment is to the patient, not the insurance company or the hospital....if this was truly a life-saving procedure, why didn't the UCLA docs go ahead with the transplant? Hospitals have to absorb all sorts of costs from underinsures, unisured, Medi-Cal patients all the time... We should be blaming Cigna......but UCLA is not an innocent bystander.

Anonymous said...

I found your blog rather interesting. Cigna Insurance is one of the few insurance companies which does not have too many negative reports. It seems to pay out the reimbursement in time, in full amount. The customer service is also impressively good. though displays people’s dissatisfaction with the company. Obviously, there are some gaps in the way the company provides its services.