CIGNA Mistakes? Maybe, but Murder…?

Posted by Michelle Minton

Imagine you are going on vacation and you pay your neighbor to tend to the hanging plants you have outside of your house. While you’re gone the weather turns and a frost sets in, eventually killing all of your plants. You return home and are understandably distraught to find out that your neighbor neglected to bring your plants indoors,  allowing them to perish in the harsh elements.  You promptly file vandalism charges against your neighbor for the damage done to your plants.  I’d wager that no court, (even one in California) would agree to hear a case on those grounds. I am willing to bet, however, that California courts will entertain the murder charges that the family of Nataline Sarkisyan plans to file against their health care provider, CIGNA.

Suffering from leukemia, complications from a previous procedure, and a failing liver, 17 year old Nataline died on Thursday December, 20th after her family removed her from life support.  The family plans to sue CIGNA becuase they claim that she would not have died had CIGNA approved coverage for the liver transplant that she needed. CIGNA, at first denied the request, claiming that because of Nataline’s illness, the complications from a previous surgery, and likely interaction of medications, that a liver transplant in her case would be “experimental” and the likelihood of success small–putting the surgery beyond the scope of the family’s coverage under CIGNA.   But, after protests and loads of negative publicity, CIGNA decided to reverse it’s decision and grant the transplant. Nataline died hours after the decision  (after her family removed her from life support).

As we don’t yet know all the details surrounding Nataline’s death, I will abstain from assigning blame, but I want to address those other commentators who place responsibility for her death squarely on CIGNA. Put simply, insurers have no responsibility to save lives. That is not what we pay them for. The only duty an insurer has is to pay for medicine and procedures agreed upon in the contract. If CIGNA broke the contract it had with the Sarkisyans, then by all means they ought to be sued, but not for murder, manslaughter, nor negligent homicide. CIGNA did not cause Nataline’s leukemia, and it did not prevent the family from receiving the transplant they claim would have saved her life, they simply declined to pay for it. The family had no right to CIGNA’s funding beyond the contract that they signed with the insurer, and by CIGNA’s account, the surgery was beyond their plan. Understanding that the surgery would have cost a massive amount of money, potentially a hundred thousand dollars or more, the family still had a choice to find alternative means of funding for the surgery.

The bottom line is that CIGNA, and any other insurer, is only responsible for providing financial coverage as their contract stipulates; nothing more.

 

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12/26/2007 @ 2:46 pm | Healthcare Reform, Insurance | Comments

4 Responses to “CIGNA Mistakes? Maybe, but Murder…?”

  1. Posted by: Michelle Minton - 12/26/2007

    The mistake I referenced to in the title, but didn’t address in the post, is in my judgment, CIGNA’s reversal in its decision not to fund Nataline’s liver transplant. If all of the evidence pointed to the fact that a transplant in her specific case would be a waste of money (and reduce the ability to fund other CIGNA members’ medical needs) then it should have stuck to that decision, barring any new medical information.

    By making an exception due to pressure from protesters and media, CIGNA showed that it can stray away from the rules when it wants to, lending credence to critics’ claims that the initial decision was arbitrary and malicious.

  2. Posted by: Welcome to managed care hell - 12/26/2007

    Cigna declined to pay because it considers liver transplants “experimental”, even though Tom Strarzl did the first successful transplant in 1967, OVER FORTY YEARS AGO. For $50,000 I can buy any opinion I want from some medical expert who never examined the patient. What that managed care pinhead at Cigna did accomplish was to purchase millions of dollars of bad publicity and public ill will, regardless of the outcome of the criminal and civil trials. I hope Geragos rips their head off with a 100 million dollar verdict.

  3. Posted by: Neil Wetmore - 12/27/2007

    The idea that insurance companies are not responsible for the lives at all costs to their clients, while their only real responsibility is to honor their contract an unattractive. It is however in line with an important and constitutional moral principle. The right to exist as an economically independent individual. The insurance company is a piece of property. It is invested in, and therefore owned, in part, by anyone who owns any shares of stock. Each investor is trying to make money, as is their right. As an enterprise, it must endeavor to be profitable. That being said, the company offers a contract. It does not force. It is not responsible to serve anyone by force. The contract is then agreed upon by a customer. The customer understands, if the customer is attentive to what is being offered, the limits of the coverage. If a circumstance occurs that is beyond the limits of the contract, the company is not morally nor legally obligated to cover the circumstance. Need does not dictate ownership. Liberty does not force man to serve his brother against his will and desires.

  4. Posted by: Michelle Minton - 12/27/2007

    To respond to “Welcome to managed care hell”

    CIGNA does not consider liver transplants experimental.
    The company approves nearly 90 percent of transplant requests.

    Nataline’s specific condition made this particular transplant an experiment. She had been in intensive care for weeks due to complications from her previous bone marrow transplant. There is also a claim (though I can’t find an authoritative source) that the anti-rejection medications Natline needed to recover from her bone marrow operation would interact with the medications necessary for the liver transplant. These case-specific factors made a liver transplant “experimental” in Nataline’s case.

    references here:
    http://www.latimes.com/features/health/la-fi-cigna25dec25,1,7386134.story

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