Well, back on the actual thread topic:
CIGNA Defends Initially Denying Teen Transplant
LOS ANGELES (CBS) -- CIGNA Healthcare officials defended themselves on Monday against allegations the insurer acted maliciously when it initially rejected a liver transplant for a Northridge teen who later died, saying its experts determined the procedure may not have been "effective or appropriate."
The memo was issued in response to the death of Nataline Sarkisyan, who died at 5:50 p.m. Thursday after being pulled off life support at UCLA Medical Center.
Her family plans to sue CIGNA, and their attorney said he will push for criminal charges against the company, alleging the insurer twice took Nataline off the liver transplant list and purposely waited until she was near death to approve the transplant because the company didn't want to pay for the procedure and her after-care.
Doctors had said she had a 65 percent chance of living for at least six months if she got a new liver, but the insurance company refused to pay for the procedure, saying it was experimental.
In a memo sent to CIGNA employees today, CIGNA President David Cordani and Chief Medical Officer Dr. Jeffrey Kang said the company consulted its own experts who doubted the effectiveness of the procedure.
"In this case, rather than going through our standard method of appeal, we went directly to not one, but two independent experts in the field who agreed that the procedure in question, given the patient's particular circumstances, would not have been an effective or appropriate treatment," the pair wrote in the memo.
Cordani and Kang insisted that the company's commitment "is to assure that our members receive the highest quality health care."
In their memo, Cordani and Kang said they cannot specifically comment on the allegations raised by the Sarkisyan family, but noted many of the accusations "have mischaracterized our decisions and intentions."
"What is often misunderstood is that most health benefit plans, whether public or private, do not cover unproven and experimental treatment related to transplants or other treatments," they wrote in the memo. "Coverage decisions under these plans are based on the best scientific and clinical evidence available, often utilizing external experts, without consideration of cost.
"At CIGNA, we facilitate payment for more than 90 percent of all requested transplants and specifically more than 90 percent of the liver transplant requests made to us."
A candlelight vigil was held yesterday in Encino for Nataline, whose case sparked protests and vows to reform the nation's healthcare system.
During the vigil, family attorney Mark Geragos said he has evidence the denial was company policy.
"Within the last 48 hours, I received e-mails from CIGNA employees who said that this was a corporate policy - to deny, deny, deny," Geragos said.
CIGNA "literally, maliciously killed" Nataline, he said earlier.
About an hour before the girl died, and as a protest by the California Nurses Association was under way outside CIGNA's Glendale office, the company announced it would pay for the transplant.
CIGNA officials said the procedure "was outside the scope of the plan's coverage" but that "despite the lack of medical evidence regarding the effectiveness of such treatment, 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."
After the girl died, CIGNA expressed "deepest sympathies" for the family.
"Their loss is immeasurable, and our thoughts and prayers are with them," the company said in a statement. "We deeply hope that the outpouring of concern, care and love that are being expressed for Nataline's family help them at this time."
In today's memo, Kang and Cordani said the company is "receiving unfair criticism," and they wanted to address employees "to make clear to all of you that in this case we fulfilled our responsibilities correctly and with the utmost integrity."
The girl's plight has made headlines around the world, and a member of the California Nurses Association said they will try to use Nataline's story to shine a light on problems with the American health care system.
"The incredible outpouring of support from Americans across the country for Nataline's family and condemnation of CIGNA's heartless behavior is inspiring - and an indication of the overwhelming public disgust with insurance companies and their restrictions on care," registered nurse Geri Jenkins, a member of the CNA/NNOC Council of Presidents who works in a transplant unit at the University of California San Diego Medical Center, said in a statement from the CNA.
Some CNA members attended the vigil, including Jill Furillo.
"What we have is a healthcare industry that makes decisions based upon the bottom line, whether or not they're going to make profits and in this case at the expense of the lives of our young people," she said.
Family members said UCLA had a liver available for transplant, but they could not perform the procedure because of CIGNA's refusal to cover it.
Nataline had been in a vegetative state for three weeks, according to her mother, Hilda Sarkisyan. The girl was diagnosed with leukemia at age 14. After two years of treatment the cancer went into remission but came back this summer.
When doctors said Nataline could use a bone-marrow transplant, the Sarkisyans discovered that her brother was a match, and he donated his bone marrow the day before Thanksgiving.
However, Nataline developed a complication from the bone-marrow transplant and, because her liver was failing, doctors recommended a transplant, according to an appeal letter sent to CIGNA earlier this month.
During last night's vigil, friends and family tried to put aside their anger to celebrate Nataline's life.
"If there's one thing she ever taught me, it was the value of human life," her friend Hovig Keushgerian said during the vigil.
Nataline's funeral is scheduled for Friday.
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