Free advertising is never good advertising

Tough calls in transplant case

A Northridge teen dies shortly after her insurer reverses its refusal to pay for a treatment it called experimental.

By Molly Hennessy-Fiske, Los Angeles Times Staff Writer
December 22, 2007

The case of a Northridge teenager taken off life support just as her insurance company reversed itself and agreed to pay for a liver transplant is highlighting tensions among physicians, patients and insurers over the definition of experimental procedures.

Nataline Sarkisyan's family blames their insurance company, Cigna HealthCare, for the teenager's death Thursday. A leukemia patient, 17-year-old Nataline had been in intensive care at UCLA Medical Center for about three weeks after suffering complications following a successful bone marrow transplant Nov. 21, relatives said. She was covered under the policy of her mother, a real estate agent.

Doctors treating Nataline told the family and Cigna in a letter that patients in similar situations have a 65% chance of living six months if they receive a liver transplant. Doctors had qualified Nataline for a transplant Dec. 6 and a liver became available four days later, the family said. But the transplant was not performed because Cigna had refused to approve and pay for the procedure, they said. (Complete Article.)

For a long time I have said that "free advertising" is never good advertising. In this case Cigna is getting a lot of national media coverage that I would bet they wish they could avoid.

First, I think the Hospital, in this case, has some liability. The Hospital should have preformed the transplant when the liver became available.

Second, I can sympathize with the family and the hospital from the standpoint of negotiating with Cigna. I experienced a similar situation a few years ago when my doctors were advising a autologous (my own) stem cell transplant.

Kansas City has a cancer clinic that does autologous stem cell transplants but my insurance company (Humana) insisted that I go to another city, like Omaha, St. Louis, Nashville, Houston, etc. Finally, they agreed that I could have it done here but there was going to be a $25,000 annual co-pay. Well, we didn't and don't have that kind of money sitting around even in a life and death situation. Fortunately, the cancer clinic and hospital worked with us so I could have it done locally. In addition, I met people in the hospital that were referred to the Kansas City clinic from the Omaha clinic.

Third, Healthcare insurers have too much power and it takes too long to appeal decisions. Too often the patient can't last long enough, as in the case above, to even hear the results of the appeal. Don't misunderstand my complaint; I'm NOT in favor of government nationalized healthcare and am strongly opposed to every Democratic presidential candidate healthcare plan. While undergoing chemotherapy I met a person who had come here from Australia to escape their national healthcare. Unfortunately, they delayed treatment in Australia long enough to cause the young man (early twenties) to lose one of his legs.

When you have cancer, you learn a lot about cancer. You also learn a lot about medicine, insurance, compassion and most of all you must keep a personal advocate with you at all times to help look out for you!