Placing the Blame

A crying shame.

Outraged family and friends are blaming a medical insurer's heel-dragging for the premature death of a California teenager who died awaiting a liver transplant.

Nataline Sarkisyan, a 17-year-old from Glendale, Calif., died Thursday just a few hours after her insurer, Cigna Health Care, approved a procedure it had previously described as "too experimental" and that dozens of Sarkisyan's supporters protested at the Cigna's headquarters.

{...}The Sarkisyan family claims that Cigna first agreed to the liver transplant surgery and had secured a match weeks ago. After the teen, who was battling leukemia, received a bone marrow transplant from her brother, however, she suffered a lung infection, and the insurer backed away from what it felt had become too risky a procedure.

"They're the ones who caused this. They're the one that told us to go there, and they would pay for the transplant," Hilda Sarkisyan said.

Geri Jenkins of the California Nurses Association said the teen had insurance, and medical providers felt comfortable performing the medical procedure. In that situation, the the insurer should defer to medical experts, she said.

"They have insurance, and there's no reason that the doctors' judgment should be overrided by a bean counter sitting there in an insurance office," Jenkins said.

Doctors at the UCLA Medical Center actually signed a letter urging Cigna to review it's decision. Nataline Sarkisyan was sedated into a coma to stabilize her as the family filed appeals in the case.

During the middle of Thursday's protest, Hilda Sarkisyan fielded a call from Cigna alerting her that her daughter's procedure had been given the green light. Cigna released a statement announcing the company "decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant."

The cheers, however, soon gave way to concern as the the hospital called to say that Nataline's health had taken a serious downturn. The family was forced to make the decision to take her off life support, and she later died. The battle to convince Cigna to support the medical procedure had taken too long.

The family said that it will now consider filing a lawsuit against Cigna -- after Nataline Sarkisyan is laid to rest. {...}

I hate stories like this. My sympathies go out to Nataline's family.

But, and there's a rather important "but" here, Nataline's parents would have you believe that Cigna is to blame for her death, rather than the lung infection that ultimately killed her. They're playing the if only game. If only Cigna hadn't denied coverage, she could have had the liver transplant, and all would be well. The big bad health insurer is to blame, once more, for another senseless. It's John Q all over again.

I don't think it's quite as clear cut as all that.

There's no guarantee that Nataline would have survived, even if she'd had the liver transplant. Transplants are risky things, and they don't always work. I'm no doctor, obviously, but it seems to me that if a young girl who was suffering from leukemia, had most likely been through some kind of chemotherapy treatment, and had already had a bone marrow transplant, would already have been somewhat immuno-compromised. Her age would have helped out some with this, though. It's a simple fact: younger people do better with cancer treatment. Yet, you have to add into the mix that she would have had to take immuno-suppresion drugs to keep her body from rejecting the transplant, and then it seems like her survival would have been a long shot. Her youth might not have helped out all that much in such a circumstance. Yet, again, I'm not a doctor, so take my analysis with a grain of salt. I'm just a former chemo patient who had a serious crash course in how the immune system works earlier this year. But the doctors were willing to do the transplant, despite the fact that she had a lung infection---that should suffice for the insurance company, right? I'm not sure. Insurance providers have to weigh the risks of paying for such procedures. As in, if Nataline had received the transplant, then had passed away, it's likely they would have faced liability for her death, then, too. It's a damned if you do, and damned if you don't situation.

The thing that bothers me about all this is why did Nataline's parents stage a protest at the insurance company, when it was most likely possible for them to accept payment liability for the transplant. Then their daughter could receive her much needed transplant, and then they could have hired a lawyer and fought it out with Cigna later. At least, by their reasoning, their daughter would now be be alive. Why is the blame laid automatically at Cigna's feet, when their daughter's health is their responsibility?

People forget that you can get health care without insurance. It happens every damn day of the week, in every hospital in this country. While I'm sure this would have been an exceptional case in terms of self-pay situations, it should have been presented as an option to the Sarkisyans. Why didn't the doctors at UCLA say, "Hey, let's do the transplant and then worry about who's paying for it later?" Why was it so important to the family that the procedure be covered by insurance? I can understand how scary it is to not have a financial safety net underneath you when you make large, expensive decisions like this. Believe me, I understand that. But that's no excuse for inaction in such a circumstance as this. I, too, have had approval for expensive procedures denied by my insurance company because of rules they have set in place, to prevent abuse of the system. But you can always fight that. And you can do it later, after the crisis has passed. Providers usually understand this. It takes a large leap of faith to do this, yes (and it usually requires a Visa card with a large limit on it, too, because they'll want at least a down payment up front.), but it's possible. The problem can be solved. Insurance companies are required by law to have appeals processes in place, so that you can always state your side of things. The procedure is listed out on the back of every single claim rejection---or even every damn letter---they send out. It's a pain, yes, but the process is there for a reason, so that insurance companies aren't later blamed for preferential treatment or, conversely, discrimination. Despite what the media and Hollywood would have you believe, insurance companies are not populated entirely by heartless bastards. While there are some glaring exceptions to that rule, for the most part, insurers do try to make sure that people get the coverage that they're paying for. The Sarkysians were obviously aware of the appeals process, too, because that's precisely what they were doing when their daughter took a turn for the worse. Furthermore, there are generally state and federal funds that could have been applied for to for assistance in paying for the transplant. Hospitals usually employ people whose sole job is to know how the system works, so that they can find the money to get paid and to keep the hospital running. Did the family not qualify for these programs? Do the programs not cover transplants? Did the hospital even inform the family of their options in this regard? There are many unanswered questions. And, from what I can see, no one's bothered asking them in their rush to tar and feather Cigna for their refusal. The questions loom large, but the main one I have is why didn't the family take the financial leap of faith that might have kept the daughter alive? Why did they think that their only option was to fight the insurance company?

Truly, it bothers me to raise these issues so soon after their daughter's death. But they're the ones who went crying to the media, so I guess that makes them fair game. I simply wish they'd seen that they had more options available to them than simply fighting the insurance company. While there's no guarantee that Nataline would still be alive today if her family had done things differently, perhaps, at least, she might have had a fighting chance.

Posted by Kathy at December 21, 2007 11:07 AM | TrackBack