Insurance Company Refused to Cover than Reconsidered Too Late

by Anna Glendenning | More from this Blogger

02 Jan 2008 11:23 AM

Welcome to 2008, hopefully your family had a better end to the year 2007 than the family of Natiline Sarkisyan. Their year ended with a funeral for their teen-aged daughter who died after her health and medical insurance company refused to pay for a liver transplant and then reconsidered.

The Philadelphia-based Cigna HealthCare insurer has a history of approving coverage for over 90% of all transplants claims requested by their insured members, with over 90% of the liver transplant request being approved according to Cigna company President David Cordani in a memo addressed to employees and distributed to the media.

Cordani said the Sarkisyan's claim was reviewed and evaluated using "evidence-based guidelines published by independent physician and medical organizations, as well as expert scientific journals."

The 17-year-old leukemia patient, Nataline was in the intensive care at UCLA Medical Center for nearly three weeks after with complications following the insured and covered bone marrow transplant she received on November. 21, 2007.

Doctors at UCLA placed Sarkinsyan on the list for a liver transplant December 6, 2007 with a liver becoming available only four days later, according to family members. UCLA informed Cigna by $letter that patients in similar situations had a 65% chance of living six months after receiving a liver transplant.

The family's benefit plan, provided through Natalines mother's employer like most health plans does not cover experimental treatments. Cigna deemed the transplant as experimental in Nataline's case and refused to pay for it.

Public outrage and a campaign supported by the California Nurses Assn., the Armenian community and the Daily Kos blog on the Internet resulted in telephone calls and e-mails to Cigna urging the insurance company to reconsider this decision.

Eventually Cigna authorized the transplant even though it was still considered experimental and outside the scope of the insurance coverage lacking medical evidence regarding the effectiveness of such treatment.

Cigna's decision was too late and was made on same the day Nataline died. Following the denial of benefits her family decided t$o take her off life support. The family blames Cigna's delay of approval for her death and have said they would file a lawsuit.

Related Blogs:

• Viewpoint: Health Insurance Dictates Treatment Options.
• Mental Health and Insurance: Advocating for Makala.
• Doctor-To-Doctor Review: Employer Provided Group Health Insurance
• Initial Denial of Authorization: The Letter.
• Copy of All Documents, Relevant to Your Appeal
• Cover Letter For Corrections to our Health Insurance Company Documentation

Other Health Insurance Blogs:

• Understanding Employer Provided Group Health Insurance
• Primary and Secondary Health Insurance Coverage.
• Mental Health and Insurance: Statistics and Other Information
• Viewpoint: Health Insurance Dictates Treatment Options.

Glossary of Insurance Terms:

A | B | C | D | E | F | G | H | I | J-K | L | M | N | O | P | Q-R | S | T | U-V | W-Z

Families.com Blogs are for informational purposes only. Families.com assumes no responsibility for consumer choices. Consumers are reminded that it is their responsibility to research their choices properly and speak to a certified insurance professional prior to making any decision as important as an insurance purchase.

Learn more about Anna Glendenning

Anna Glendenning is a mother of four. Two biological children grown and out of college, and two siblings and adopted together in 2003. Anna's Personal Website http://www.adoptiveparentsnetwork.

View Full Profile | More from this Blogger

Anna Glendenning (4234) 12 Jan 2008 11:29 PM

From my understanding Cigna had covered a bone-marrow transplant which led to complications with her liver. Apparently, the need for the transplant was rather rapid and I believe it was only a matter of weeks. The position of the family and their legal coucil is that the Original medical procedure was covered and led to the need for the liver and the position of the family is that the liver transplant should have been unquestioned as it was caused by the original covered medical procedure... It will be interesting to see the outcome of this case, as it has some huge implications.

garybrown (25) 02 May 2008 03:03 PM

Way bad timing on Cigna's part. If would interesting to hear and know Cigna's side of this story. I feel very sorry for the family. The lawsuit won't bring their daughter back but maybe Cigna will be found liable and force them to readjust their processes. http://www. choicearizona.com

progamer1 (5) 21 Jul 2008 10:25 AM

These things happen too often. Recently the human life was re evaluated to only be worth $7 million--big drop there. http://www.youtube.com/watch?v=fCMiYYT_lXE

insurancequotes (5) 27 Nov 2008 09:23 PM

The problem seems to be that so many people don't read the policies, but also unfortunately insurance companies try to find loopholes which shouldn't happen.

Just another reminder to not only shop for price, but also the coverage that you are getting.

symonds (15) 20 Mar 2009 03:28 AM

Hi I really thankful to you because you are simply great. I am very happy to post my comment in this blog. I gathered lot of information from this site. Nice blog.

Make Money

finalexpenseinsurance (16) 13 Apr 2009 10:32 PM

"Evidence-based guidelines" are the new fad in physician training. At bottom they direct a physician's diagnosis ONLY to those diseases which have been proven previously to be associated with the observed symptoms.

Very good you say, but I disagree! This unnecessarily limits a physicians ability to choose treatments that present outside the norm with consequences as you see here.

DavidMickelson (15) 06 Jul 2009 10:52 PM

Choose the right Life Insurance Settlement Option and avail Best Life Settlement Services from professional Life Settlement Brokers.

msclockey (15) 18 Aug 2009 01:22 AM

I realize that this comment is after the fact. what was the outcome of the lawsuit? Did the family get reimbursed for the error that was made by the insurer?

AndrewBrinkworth (5) 26 Aug 2009 05:47 PM

So when asked the question of the day, Do you want to have a politician between you and your doctor? I must ask, can it be any worse than having a person who doesn't want to spend any money between me and my doctor? The sad thing here is that this whole thing could have been avoided and the young girl could be alive today. My prayers go out to her family. Andrew Brinkworth Miami Auto Insurance