Friday, December 21, 2007

Teen dies after CIGNA first denies transplant, then reverses decision

Natalee Sarkisyan, a 17-year-old from Glendale, Calif., died Thursday just a few hours after Cigna Health Care, her medical insurer, approved what they previously had described as "too experimental" a procedure and the same day that dozens of Sarkisyan's supporters protested at the insurer's headquarters. (ABC)


This is disgusting. You want to know what the Big Insurance companies are like, you just have to read this Yahoo News story in its entirety:

GLENDALE, Calif. - A 17-year old died just hours after her health insurance company reversed its decision not to pay for a liver transplant that doctors said the girl needed.

Nataline Sarkisyan died Thursday night at about 6 p.m. at University of California, Los Angeles Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.

"She passed away, and the insurance (company) is responsible for this," she said.

Nataline had been battling leukemia and received a bone marrow transplant from her brother. She developed a complication, however, that caused her liver to fail.

Doctors at UCLA determined she needed a transplant and sent a letter to CIGNA Healthcare on Dec. 11. The Philadelphia-based health insurance company denied payment for the transplant.

On Thursday, about 150 teenagers and nurses protested outside CIGNA's office in Glendale. As the protesters rallied, the company reversed its decision and said it would approve the transplant.

Despite the reversal, CIGNA said in an e-mail statement before she died that there was a lack of medical evidence showing the procedure would work in Nataline's case.

"Our hearts go out to Nataline and her family, as they endure this terrible ordeal," the company said. " ... CIGNA HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant."

Officials with CIGNA could not immediately be reached for comment Thursday night.

CIGNA doesn't give a crap about the health of its customers, or even providing coverage to its customers. All CIGNA cares about it keeping its excessive profits from the expensive premiums it charges its customers, while avoiding any sort of expensive payments for medial coverage its customers need. This is a legalized extortion racket that CIGNA and the Big Insurance companies are involved in. What is even more amazing is that CIGNA only reversed itself about providing coverage for the liver transplant to Sarkisyan only after teens and nurses protested outside of CIGNA's office. In other words, CIGNA reversed its decision not because of Sarkisyan's medical needs, but rather to save its public ass from negative media coverage of these protests. Nataline Sarkisyan died before the transplant could take place, and CIGNA didn't have to pay the money for the transplant.

This country needs some form of nationalized health care. The system is broken. There are around 46 million Americans that are uninsured for health care coverage--going into the hospital or emergency room will financially wipe them out. We have Big Insurance companies that currently hold all the power because they are the ones who decide which medical coverage and procedures are to be paid out to customers. What we have here is health insurance coverage that is paid out by bean counters. Consider this detail from the ABC News story, titled Time Runs Out for Transplant Teen:

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.

CIGNA bean counters made the decision regarding Sarkisyan transplant--not the doctors. And bean counters are only interested in how much profit CIGNA can make. According to this November 2, 2007 Yahoo Finance story, CIGNA's 3rd quarter profit "rose 22 percent on increased premiums and fees." Continuing with the Yahoo Finance story:

Cigna, which also sells disability and life insurance, said net income climbed to $365 million, or $1.28 per share, from $298 million, or 92 cents per share, a year earlier.

Adjusted income from operations totaled $323 million, or $1.14 per share, compared with $268 million, or 83 cents per share, a year earlier. Adjusted income from operations totals income from continuing operations excluding realized investment results and special items.

Total revenue rose to $4.41 billion from $4.14 billion in the 2006 quarter.

Analysts surveyed by Thomson Financial expected profit of 94 cents per share on revenue of $4.41 billion.

Prospects are good that Cigna can generate sustained growth, Ed Hanway, Cigna's chairman and chief executive, said during a conference call with analysts.

Looking ahead to 2008, however, Cigna expects to post adjusted income from operations of $1.16 billion to $1.21 billion, or $4 to $4.20 per share, missing Wall Street average expectations of $4.23 per share.

Heath care profits are expected between $740 million to $780 million in 2008 and medical membership should rise by 3 to 5 percent without acquisitions.

"They gave relatively weak guidance for growth in the health care segment," said Peter Costa, an analyst at FTN Midwest Securities.

The third quarter's earnings lift didn't come from Philadelphia-based Cigna's core health care business, whose adjusted earnings after taxes fell 2 percent to $173 million.

Premiums and fees climbed 7 percent to $2.6 billion as medical membership grew to 10.2 million from 9.3 million. Despite the growth, though, margins fell to 5.7 percent from 6.1 percent a year ago.

Even though premiums and fees climbed, margins fell. I guess the bean counters at CIGNA didn't need another expensive liver transplant for a 17-year old teen to reduce their profits.

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