Teen Dies; CIGNA Blamed

Private health insurers have a vested financial interest in denying expensive care to their patients. If that means patients die, so be it. But the results are evil. We need a government solution, and we need it yesterday.

This further illustrates why insurance is ridiculously expensive. Policy holders wanting more coverage than they paid for, a lawsuit worth millions, policies rewritten to provide less coverage, and legal ramifications deciding a patient's care instead of a doctor. The whole system needs to be addressed before only 5% of the US can afford sound medical care. Government or not, a solution is definitely overdue.

another perfect example of the medical system and
it's intervening, overpowering but charge me double,
paper system join forces on our behalf. You're only
a "rejection" away from death.
This poor dad, had to lose his 17 year old, after
3 years of fighting a disease to try and save her,
and some "paper system" over-rules.
It could be any one of us. And how much do we pay
per month? per year? per 10 years?

In the letter, Deborah Garnsey, a registered nurse who reviews cases for CIGNA, said she had reviewed the family's appeal Thursday and decided "to make an exception in this rare and unusual case."

A registered nurse made this decision?

The doctors and hospital were, of course, only concerned with the girl's well-being... but WOULDN'T perform the procedure until CIGNA forked over thousands of dollars.

This isn't about insurance and health, it's about WHO GETS PAID. Greedy doctors, greedy hospital, greedy insurance company. Don't single one of the three out and give a pass to the others.

Of course the insurance companies want to consider creating some kind of additional insurance for "certain" experimental procedures - it's one more way they can get money out of the consumer! Greedy b*stards. If physicians involved in this kind of extraordinary case say a procedure is necessary, the insurers should be required to cover it regardless of whether or not some cubicle jockey doctor who hasn't practiced medicine in decades thinks it's necessary.

At the same time, under a socialized medicine system, these kinds of procedures would still be subject to review and denial - except it'd be an overpaid federal employee rather than an overpaid private employee. Most socialized medicine systems have limits when it comes to experimental treatments, particularly organ transplants. Under the UK's NHS, people who are deemed mentally retarded are not eligible for heart transplants, people over a certain age (55 or 60) aren't eligible for kidney transplants, etc. There ARE limits under those medical systems, which may make it even less likely that such "experimental" procedures would even be suggested by physicians, much less performed.

Sadly, the CNN article said the girl had been in a vegetative state for several weeks. Sometimes patients are just too sick to make it, regardless of what treatments one might try to throw at the disease(s), and regardless of who is paying for those treatments (a private insurer or fellow taxpayers).

Matt wrote:

Private health insurers have a vested financial interest in denying expensive care to their patients. If that means patients die, so be it. But the results are evil. We need a government solution, and we need it yesterday.

You are aware that a "government solution" could lead to even more stringent guidelines surrounding procedures deemed experimental, right? No medical system, privatized or socialized, is without limits. Under socialized medicine, services will go towards patients who are deemed most likely to survive with treatment - it will just be more consistent guidelines and rules across the board, rather than slightly different rules for each individual insurer and some people being left in the cold completely.

I agree wholeheartedly that our medical system is broken. I would like a system of basic healthcare with the option for additional private insurance for a higher level of coverage (similar to the UK's National Health System). But to presume that a "government solution" would have resulted in any different outcome for this girl is foolhardy.

How about an unpopular, but a very real concern.

"Doctors treating Nataline told the family and CIGNA in a letter that patients in similar situations have a 65 percent chance of living six months if they receive a liver transplant."

This young lady was in a coma prior to surgery, what quality of life would she have had after the surgery?

Could have or did this donated liver go to a recipient that would better use this organ, who would have had a better quality of life? Think about the 65% chance of 6 more months. I am certainly not a insurance company proponent, but remove the emotional side from this story and ask yourself. Would this have been an appropriate use of a donated organ?

If the circumstances were different would Cigna still fought the payment of this procedure? Most likely.

I just wonder if the Courant would report this had this been a story about a 40 year old person who received their third kidney transplant because they refused to adequately care for themselves after the first two transplants?

Let me first say that I truly feel for this girl's parents, I can't imagine losing a child. However, having been on both sides of this issue there is no easy solution. I have been working in the health insurance industry for over 30 years and am also a person refused medical treatment because my insurance company deemed it medically necessary.

Believe me there is no easy solution. We as patients want all our medical care covered. The insurance companies are making decisions based on the coverages affored by the policies. But stop and think too that the hospitals and doctors also bear some responsibility. The fees they charge for medical procedures are absorbitant. I see it every day and am amazed at the fees are charged for even for the simplest procedures.

How can a doctor at an insurance company make a decsion to deny medical treatment unless he has actually examined the patient? But on the other hand, some doctors request expensive tests and treatments that aren't really necessary because they are afraid of medical malpractice suits. It's a vicious circle.

Someone has to put a stop to it and find a solution that will benefit people like this young woman's family and everyone else who has been in this situation.

Instead of spending so much time fighting and name calling amongst themselves Republican and Democratic politicians need to find a way to fix this problem.

So when are the CIGNA execs going to be arrested and tried for negligent manslaughter? Not much difference between this and running someone down and driving away.

What a dumb statement. I agree that this is sad, but how many hundreds of thousands of dollars for 6 months in a hospital bed. It seems as if we are forgetting that people die and doctors are just people trying there best in very difficult situations. They can not stop everyone from dieing. Sometimes we just need to let nature take its course. Sad but true.

Phritz the Kat wrote:

So when are the CIGNA execs going to be arrested and tried for negligent manslaughter? Not much difference between this and running someone down and driving away.

I have to commend (most of) the folks who have posted here -- for exercising their judgment on this difficult issue, rather than posting emotionally satisfying, but irrational, rants about big-business health insurers.

Natline's family can be excused for their public statements. On the other hand, their lawyers' demand for prosecution of the Cigna employees is unprofessional and borders on unethical. He might as well call for prosecution of the doctors and hospital officials who knew they were dealing with a life-and-death situation yet chose to withhold the procedure this young woman needed to survive. That too would be wrong.

The right answer is the one so many on this board have alluded to -- that we use this case to consider again how medical care is provided in this society. And the hard reality is that ANY rational system will inevitably wind up denying some care to some people who feel they are owed it. It can't be any other way.

I have cigna maybe its time to stop paying them and get another insurer

BOB wrote:

The doctors and hospital were, of course, only concerned with the girl's well-being... but WOULDN'T perform the procedure until CIGNA forked over thousands of dollars.
This isn't about insurance and health, it's about WHO GETS PAID. Greedy doctors, greedy hospital, greedy insurance company. Don't single one of the three out and give a pass to the others.

BOB: You hit the nail right on the head! If the doctors truly cared about the health of their patient, they would have done the operation immediately & worry about the paperwork & money later. Isn't that what the "Hippocratic Oath" doctors are supposed to take is all about? Interestingly enough, you hear of cases where children from foreign countries are flown here for free & given free medical care for corrective surgery (the little girl with a parasitic twin, severe clef-lip palates, etc.). Why isn't the same free care given to AMERICAN CHILDREN???!!!

Matt wrote:

Private health insurers have a vested financial interest in denying expensive care to their patients. If that means patients die, so be it. But the results are evil. We need a government solution, and we need it yesterday.

They should have a vested financial interest in the health and prolonged life of customers that pay for insurance. I'm sure at one time bypass surgery would have looked risky, but there is no question now that it saves lives. This girl had a 65% chance of survival from the liver transplant. It was an opportunity for the girl to live and the hospital staff to gain experience for the next transplant.

Laura wrote:

The right answer is the one so many on this board have alluded to -- that we use this case to consider again how medical care is provided in this society. And the hard reality is that ANY rational system will inevitably wind up denying some care to some people who feel they are owed it. It can't be any other way.

Your simply wrong.You have set the bar low.

What we have now is a system with health insurance that's main purpose is to make a profit for the shareholders...that's mandated by law.

What we dont have is a Healthcare Payment System that mandates payment for Health care its is top priority.

How about a rational system that will be able to give care to anyone who wishes it.

Start with a lofty goal and achieve it..dont accept that "good enough" is all that we can do

BOB wrote:

The doctors and hospital were, of course, only concerned with the girl's well-being... but WOULDN'T perform the procedure until CIGNA forked over thousands of dollars.
This isn't about insurance and health, it's about WHO GETS PAID. Greedy doctors, greedy hospital, greedy insurance company. Don't single one of the three out and give a pass to the others.

first of all, such a surgery is CRAZY expensive. it would cost thousands upon thousands of dollars. how many people would be willing to fork over that kind of money to save a life? secondly, why would they, HOW COULD they make the decision to provide this liver to someone who can't pay versus someone else who needs it and CAN pay? people wait YEARS for a good donor. how would you feel if you needed a liver and it went to someone who got it for free?

what happened to this young girl is a sign of how evil insurance companies are. i work in a pharmacy and i cant tell you how many times insurance companies refuse to pay for vital medicine, sometimes even lovenox (to prevent blood clotting), and asthma medications, both of which are VERY expensive. my job isnt even giving out rx's at this point. i get paid to fight with insurance.

this is also why we CANT have universal health care. think of how much cigna costs, and thats the kind of treatment they give? can you imagine if it was the government paying for insurance for 200 million people? she probably wouldnt have been in the hospital at all....

all that being said, i'm sorry this girl passed so early. i hope to do cancer research one day, and it is cases like hers that drive my ambition. her family and friends are in my thoughts.

Yet another shining example of the priorities of todays' humanity. Especially during the Christmas season. To put a dollar before possibly extending the life of a 17 year? They deserve to be sued for not even trying to do the right thing.

What is the price of a human life? Is it really something that can be measured by business standards, or by dollars and cents? The whole idea of medical treatment as a for profit entity is ridiculous. That poor girl deserved a chance at life the same as anyone else, health insurance notwithstanding. To withhold medical treatment because no money was forthcoming is reprehensible, and possibly criminal. This is an ugly situation, created by an ugly health care system. Those at CIGNA who made this decision should hang their heads in shame, and those doctors should question their commitment to saving human lives.

how is this really cigna's fault if this was an illegal immigrant the doctors would have given them the transplant no questions asked