Calif. teen’s family sues Cigna over transplant

LOS ANGELES – The family of a 17-year-old leukemia patient has sued health insurance giant Cigna Corp. for her death in 2007 after the company initially refused to pay for a liver transplant.

The lawsuit filed last week in Los Angeles County Superior Court by the family’s attorney, Mark Geragos, alleges breach of contract, unfair business practices and intentional infliction of emotional distress. The suit accuses Cigna of delaying and rejecting valid claims, which resulted in the wrongful death of Nataline Sarkisyan.

The Philadelphia-based insurer eventually approved the transplant after Sarkisyan’s family held a rally outside Cigna’s suburban Los Angeles office. Nataline, however, died hours after the approval was secured.

Chris Curran, a spokesman for Cigna, said the company empathizes with the family but feels the lawsuit is without merit. Curran said Cigna volunteered to pay for the procedure out of its own pocket and not the employer’s.

“This decision was made despite the fact that Cigna had no obligation to do so and despite concluding, based on the information available, that the treatment would be unproven and ineffective and therefore experimental and not covered by the employer’s benefit plan,” Curran said, reading from a statement.

But Charles Idelson, a spokesman for the California Nurses Association, said insurance companies are “in business to provide profits for shareholders, not to provide care.”

“Nataline Sarkisyan’s case serves as a tragic poster child for everything that’s wrong with our insurance based health care system,” he said. “Why did it take public humiliation for Cigna Corporation to approve a transplant?”

Nataline was diagnosed with leukemia at 14 and received a bone marrow transplant from her brother the day before Thanksgiving 2007. A complication, however, caused the teen’s liver to fail.

The family had asked Cigna to pay for a liver transplant but the insurer refused, calling the procedure experimental.

In a subsequent letter to Cigna, four doctors from Mattel Children’s Hospital at UCLA Medical Center appealed to the insurer to reconsider. They said patients in similar situations who undergo transplants have a six-month survival rate of about 65 percent.

The insurer eventually reversed the decision while about 150 nurses and community members rallied outside its office in Glendale.

By this time, however, the teen had fallen into a vegetative state and was taken off life support. She died within the hour.

Doctor’s Note:

This is happening more and more with the insurance companies in general.  They have been raising their premiums and lowering there coverage payouts and procedures for years now.  They have even started rejecting claims that are compliant with their requirements.  Our office utilizes Eclaims or Electronic claims.  These claims are computer generated and uses a program to check for any mistakes and ensures accuracy so claims don’t get rejected.  They still get rejected and after they have been resubmitted exactly the same way with no changes, it gets accepted.  I believe that these insurance companies are rejecting claims to hold on to our premiums a few more days to collect on the interest and increase their profit margin.

The way things are now, I believe that the insurance companies will be in need of our next “bailout” in the next 15 years or so.  The current system is going to bankrupt itself eventually.  Sadly, I have not seen a way to fix this problem and I am not sure if there will be a solution in the near future.