VICTORY - CIGNA Agrees to Liver Transplant

[unapatriciated]

OOPS - Too Late
http://www.michaelmoore.com/words/latestnews/index.php?id=10576

[helderheid]

1. K&R and welcome to DU!

:hi:

We are in a heap of trouble.


Rest In Peace

:cry:

:mad:

[Warpy]

2. Welcome to DU, and that's how for profit insurance

does its job best--waits until the person is dead and then approves the treatment.

Any universal health care scheme that leaves those bloodsuckers in control is a scam.

[BrklynLiberal]

3. I hope this posthumous approval makes it possible for her family to sue their asses off!!!

[ThatsMyBarack]

30. They shouldn't protest because....

:sarcasm:....some rent-a-cop at the CIGNA company will tase them all!:sarcasm:

[unapatriciated]

31. They can but ....

The ERISA Act protects them. I tried to sue my HMO for delaying testing and treatment that left my son unnecessarily crippled that's when I found out about HMO"S protection under the ERISA Act. Mine was in the early 90's I hope things have changed.

[Avalux]

4. Very sad, but I have to say this.

After reading about Nataline's condition, the liver transplant would probably not have done much good. This young woman had received a bone marrow transplant for a leukemia relapse and was gravely ill afterwards; not only did she suffer liver failure but her other organs were failing; she was in a vegetative state. It would take me awhile to explain the complications that can arise from a BMT so I won't get into it.

Please keep in mind this young woman was very, very ill and probably would not have survived the surgery for the liver transplant.

My condolences to her family. :-(

[lame54]

5. This is from an earlier article...

http://www.michaelmoore.com/mustread/index.php?id=944
Medically speaking, her doctors say that she is ready for the transplant. They also believe that her other organs will recover on their own if the liver is transplanted. CIGNA has ignored this medical decision and calls the transplant “experimental” as justification for denying the treatment.

[slackmaster]

7. OK, they disagreed with her doctors' assessment at that time

I would expect an individual patient's physicians to maintain an optimistic assessment of her chances. They have a financial incentive to try to get the surgery funded whether she ultimately lives or dies; and they certainly do want to give her every available chance.

Any medical insurance system is going to have a system of checks and balances to ensure that care is in effect rationed to those who are most in need, and also most likely to benefit.

Not being a technical expert, I am certainly not in a position to say with certainty that the insurance company was wrong. Maybe they were. I hope someone can figure it out and get some clarity on this.

[bobbolink]

14. "Any medical insurance system is going to have a system of checks and balances"

Yes, it's called PROFIT MOTIVE.

[slackmaster]

21. Which would be fine if not for the fact that letting people die is sometimes more profitable

Than giving them critically needed care that may or may not work.

[bobbolink]

27. Exactly the point.

Imagine your fire department being run by "the profit motive."

[Canuckistanian]

29. Her doctors had "financial incentive" to get her surgery funded?

How about just doing what they were trained to do, which is to heal sick people?

You have a very low opinion of physicians. All physicians I know don't give a damn about the money they get. If a patient dies needlessly, they're pissed.

Maybe it's different in America.

Sorry, that comment set me off. The insurance companies are greedy. I don't see physicians having the same motives.

[TalkingDog]

33. system of checks and balances- most likely to benefit. HAAHAHAHAHAHA!!!!

Really?

Is that why the insurance panel declared my treatment for lead poisoning (which was developed by the US Govt. in WWII for soliders with lead bullets in inoperable locations) was experimental? And when I got a lawyer to question the panel of NON-MEDICAL assessors in order that they might defend how they deem a treatment experimental, they replied: "A treatment is experimental when we say it is."

Really? All about checks and balances? All about the best benefit for those that would do well with the treatment?

Wow. I wanna live in your world. Where everybody has everybody else's best interest at heart. And the doctor's only say and think optimistic, hopeful things about critically ill patients, even though that would directly negate their overarching directive of "do no harm". And all the people from insurance companies ignore the bottom line of their for profit employer and only do what is good and right and just....and rainbow puppies romp and play with cotton candy kittens and silver moonbeam unicorns kiss lovely virginal maidens and the war is not really a war, they are really only throwing marshmellows at each other, while they laugh and sing together and all those emaciated poor people you see in dirty rags aren't suffering. They really LIKE they way the look when they are doing a lifetime fast and they know that consumerism is much too over-rated so the rags- which are really made of the softest, magically dirt-shedding silk- are just a conscious statement about the few misguided souls who spend too much time away from their loving families in order to make unnecessary amounts of money.

Hey, if that comes in a pill form, send me a few, why don'tcha.



My Favorite Master Artist: Karen Parker GhostWoman Studios

[Avalux]

9. But would she have recovered from the BMT?

This is a very complicated case and I'd like to know if her doctors thought she'd recover from the treatment for her leukemia. I can understand why CIGNA called the transplant "experimental". The mortality rate for someone in her condition is high; if livers were a dime a dozen, it probably wouldn't have been an issue.

[Tyler Durden]

26. She was 1A status for the liver transplant

They don't give you 1A status unless they are pretty damned sure you'll live through the procedure and the prognosis is good.

This has nothing to do with TRIAGE, CIGNA does not have the right to practice medicine and do MEDICAL TRIAGE.

[slackmaster]

6. I agree with you sparosnare, and thanks for having the courage to post it

It appears to me that CIGNA's position was that they regarded a liver transplant as an experimental procedure in the context of that particular patient's gravely degraded condition. They and other companies have funded liver transplants many times.

Please keep in mind this young woman was very, very ill and probably would not have survived the surgery for the liver transplant.

That may be true, AND attempting to give her a good liver might have prevented another needy person from getting it and surviving. I think the knee-jerk reactions condemning CIGNA's behavior here are understandable, but probably not justified in this particular case.

[spinbaby]

10. You're right about her condition

It should never have been an insurance issue, because she shouldn't have been on a transplant list in the first place. There too few organs available to use one on someone who's not likely to survive the surgery. But, that said, the insurance company shouldn't be deciding who gets a transplant.

[supernova]

12. Exactly right

I find it beyond ghastly that insurance companies are in effect practicing medicine without a license.

And no, having an MD on staff who's job it is to decline payments, is no substitute for the treating physician's judgment.

Why don't insurance companies ever get sued for malpractice when they decline to pay, in effect denying treatment for people they admit they know only the most cursory information and sometimes not even that?

[helderheid]

13. What a great question! Why indeed?

[bobbolink]

15. Why don't insurance companies get sued? Not many Davids will take on the Goliaths!

Remember Erin Brockovitch?

[unapatriciated]

32. Why ? Check out the ERISA ACT

It's not easy but things are beginning to change.

http://findarticles.com/p/articles/mi_qa3841/is_200112/ai_n9015419

[Avalux]

11. I've worked with patients in similar circumstances.

It's not a popular stance but it's reality. She was experiencing organ failure for a reason and no one seems to be talking about the underlying illness/treatment and mortality rates. The first article I read coined her as "a cancer survivor" which she was, but she was also in the midst of a leukemia relapse and treatment.

[Occulus]

16. You need to head over to Kos and read nyceve's diary on this.

Now, today. There are details in the comments you apparently don't know about.

For instance:

In a Dec. 11 letter to CIGNA’s transplant department, four UCLA physicians said that Nataline "currently meets criteria to be listed as Status 1A" for a transplant and urged the company to "urgently re-review her case" and their denial. CIGNA said it denied the care because their benefit plan "does not cover experimental, investigational and unproven services," to which the doctors replied, "Nataline’s case is in fact none of the above."

On Dec. 14, Hilda Sarkisyan was told by the hospital that a healthy liver was available, but because CIGNA had refused authorization, the family would have had to make an immediate down payment of $75,000 to proceed, an amount the family could not afford.

Read ALL the comments. Those who are saying she was too sick for the surgery appear to be just flat-out wrong, uninformed, or (in some cases) perhaps being paid to dumb the outrage down a bit.

The truth is, when they found a liver for her, she was healthy enough for the surgery. CIGNA delayed, and ran out the clock. They only caved when it became clear that she wouldn't survive the rest of the day.

This was murder by spreadsheet.

[lame54]

17. thank you - very imformative

[Occulus]

19. y/w

I'm getting very sick of hearing "we don't know the whole story" when we do in fact know enough to come to a conclusion or five.

And every time I hear it, it sounds like a defense. Just sayin'.....

[supernova]

20. "This was murder by spreadsheet."

:wow:

Wish I could recommend this post.

That distills the problem to a T.

[slackmaster]

22. That information is indeed new to me

Thank you. If that is all accurate, the question becomes whether CIGNA simply made an error, or there was a conscious decision to deny treatment that might have saved the patient and try to cover it up as an error.

This needs to be investigated thoroughly.

[Beelzebud]

8. I hope the decision makers at that place cant' fucking sleep at night.

[Occulus]

18. According to sparo above, "we don't have all the facts"

Blah blah blah. How MANY times have we heard someone on this board pooh-pooh something with "we don't have all the facts", only to find out later on that in fact everything people were assuming is true was, in fact, true?

How many times are truly bad events- evil on their face- going to be pooh-poohed away with the tired old "we don't have all the facts/we don't know the whole story", when the facts we DO know, on their face, are bad enough to be able to directly, confidently, point the finger of culpability squarely at those who are culpable?

"We don't know all the facts?" Fucking cop-out! We know enough to say CIGNA killed her. That's all we need to know.

[lame54]

23. Here's a fitting joke about that

President Bush said Thursday he will reserve judgment on his administration's destruction of CIA interrogation tapes until several inquiries are finished. "Let's wait and see what the facts are," Bush insisted. Translation: "My lawyers need more time to weasel me out of this."

[slackmaster]

24. Yes, and sometimes "we don't have all the facts" means

That we really don't have all the facts.

I know that I don't have all the facts.

[Tyler Durden]

25. Then perhaps you need to collect some facts.

1A status in transplants is the highest priority, first on the list.

You don't get 1A UNLESS they are DAMNED SURE you will live through the surgery and take the transplant. This person was status 1A.

THOSE are some of the facts, so if you are arguing just for the entertainment value, some of us out here this story hits pretty close to home.

[malaise]

28. A very sad story

Bush should be proud of his great health care. :puke: