About this time last year, we reported on the sad case of Nataline Sarkisyan. Our post on December 21, 2007, began:
"The family of a 17-year-old girl who died hours after her health insurer reversed its previous decision and said it would pay for a liver transplant planned to sue CIGNA HealthCare, their attorney said Friday."
And it appears that this is, indeed, coming to pass:
"An insurance company that initially refused to pay for a liver transplant for a 17-year-old Northridge girl who died in a hospital should face criminal charges and pay civil damages, an attorney for the girl's family said Friday."
Lead attorney Mark Geragos went on to rant that Cigna HealthCare "literally, maliciously killed" Nataline Sarkisyan."
Well, to be fair, that's what he's paid to say, even if it lacks actual, you know, truth:
"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."
Those who doubt that "public" benefit plans withhhold such vital services need only peruse Bob's post on Sabrina Holloway.
And, in fact, Cigna went out of its way to justify its refusal to cover such an experimental procedure. Unfortunately, they did cave, and agreed to pay for the risky surgery, which ultimately failed to keep poor Nataline alive.
As regular reader Matt H points out, that was really Cigna's biggest mistake:
"Cigna should have stuck to the contract. I bet they will have to pay a settlement now because of their change of mind."
That sounds about right:
Had they simply stuck to their guns in the first place, the outcome wouldn't have changed (Nataline wouldn't have survived), but they also would have a compelling defense. As it stands, by backing down in the name of PR, they face an uphill battle. My guess is that the case will be based on the simple question of timing: if Cigna had agreed to cover the surgery immediately, the argument will go, then Nataline would surely have survived. By "dithering" (i.e. actually following the correct process) Cigna reduced her chances of survival.
We'll never know, obviously, whether that would have been the case, but I think that Cigna erred in succumbing to public pressure. Had they stood their ground, such a lawsuit likely would have had little chance of success. As it stands, I think Cigna will be paying out quite a few more dollars.
If there's any silver lining, it's that perhaps other carriers will learn the correct lesson from this unfortunate event.
[Hat Tip: Reader Matt H]
UPDATE: In the comments, Chad asks a very good question:
"Why is there no condemnation for the doctors and hospital that withheld this supposedly vital, lifesaving treatment for want of payment?"
I made a similar observation in my original post last year:
"(T)he actual choice belonged solely to the parents and the provider."