Couple battle to make insurers liable for coverage decisions

strollingbones

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Sep 19, 2008
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interesting read...they lost their daughter due to insurance refusing a liver transplant...then find out ....you are blocked from suing insurance companies and how protected insurance companies are....basically how the courts allow insurance companies to fuck their clients and let them die...

Couple battle to make insurers liable for coverage decisions -- latimes.com

By Lisa Girion - Surrounded by supporters, Hilda Sarkisyan marched into Cigna Corp.’s Philadelphia headquarters on a chilly fall day, 10 months after the company refused to pay for a liver transplant for her daughter.

"You guys killed my daughter," the diminutive San Fernando Valley real estate agent declared at the lobby security desk. "I want an apology."

What she got was something quite different.

Cigna employees, looking down into the atrium lobby from a balcony above, began heckling her, she said, with one of them giving her "the finger."

Sarkisyan walked out, stunned and hurt.

"They showed me their true colors," she said. "Shame on them."

Cigna later apologized for the 2008 incident, but it has now become -- unintentionally -- the central element of a lawsuit Sarkisyan and her husband, Grigor, are pressing against the health insurer.

The suit began as a wrongful-death complaint, with the couple contending that Cigna's refusal to cover the transplant led to Nataline's death Dec. 20, 2007, in a case that drew national media attention.

A Los Angeles judge threw out the wrongful-death complaint, saying it was barred by a 1987 U.S. Supreme Court ruling that shields employer-paid healthcare plans from damages over their coverage decisions.

But U.S. District Judge Gary Allen Feess said the Sarkisyans could pursue damages for any emotional distress caused by the Philadelphia incident.

The ruling was bittersweet for the Sarkisyans and patient advocates, who say it points to the need for federal legislation to allow people to sue health insurers for the life-or-death decisions they make.

"They kill a beautiful 17-year-old girl, and I get to go after them for a finger? That's sick," Hilda Sarkisyan said.

The Sarkisyans contend that Cigna improperly refused the transplant that Nataline's UCLA physicians said at the time was urgently needed to save her life, and that the company reflexively issued a denial letter without looking into the specific circumstances.

The company said at the time that, for Nataline, the operation would have been experimental and was not covered. Nine days later, amid a storm of publicity, Cigna agreed to cover the transplant.

It was too late. Nataline died hours later.

read the full article.
 
When you take out private insurance you are betting against yourself, and like any casino the HMOs have the odds figured out in their favor.

Any actuary will tell you the more people in a health care plan the more effective it is.

As in universal cover?

Now I know the government can fuck that up, but still, why put all your ills in one basket, private or public?
 
Many big insurance companies, mega corporates and big banks own most judges and many politicians. They all need to be stomped out.
 
Any actuary will tell you the more people in a health care plan the more effective it is.

and the proper ratio of high risk to low risk members. The profit that now goes into the hands of private insurance companies will be gobbled up by government beauracracy if we go with socialized health care.
 
I feel for the parents, but for them to claim the insurance company "killed" their daughter is bullshit. The child had recurrent leukemia and multiple organs were failing. The disease killed their daughter, not the insurance company.
 
I feel for the parents, but for them to claim the insurance company "killed" their daughter is bullshit. The child had recurrent leukemia and multiple organs were failing. The disease killed their daughter, not the insurance company.
But didn't the insurance company have an obligation to give their daughter that shot at life by paying for the procedure that could prolong her life? Or is it the insurance companies right to say she's going to die anyway why waste the money?
 
Buying health insurance has NEVER meant that they will pay for everything possible to ensure that you have a long nor healthy life. It's a security racket that people fall for.
 
I feel for the parents, but for them to claim the insurance company "killed" their daughter is bullshit. The child had recurrent leukemia and multiple organs were failing. The disease killed their daughter, not the insurance company.
But didn't the insurance company have an obligation to give their daughter that shot at life by paying for the procedure that could prolong her life? Or is it the insurance companies right to say she's going to die anyway why waste the money?

Seems that Cigna did say they would pay for it,
Does Cigna Deserve All The Blame? - Forbes.com
snip,
On Thursday, Dec. 20, 150 nurses picketed Cigna. Many more called the company. Later that day, Cigna contacted Geragos and UCLA to say it was making a one-time exception to the process and would cover the treatment. Though the company still believed it was experimental, it would pay out of its own pocket (not that of Nataline Sarkisyan's mother's employer) for the procedure.
 
interesting read...they lost their daughter due to insurance refusing a liver transplant...then find out ....you are blocked from suing insurance companies and how protected insurance companies are....basically how the courts allow insurance companies to fuck their clients and let them die...

Couple battle to make insurers liable for coverage decisions -- latimes.com

By Lisa Girion - Surrounded by supporters, Hilda Sarkisyan marched into Cigna Corp.’s Philadelphia headquarters on a chilly fall day, 10 months after the company refused to pay for a liver transplant for her daughter.

"You guys killed my daughter," the diminutive San Fernando Valley real estate agent declared at the lobby security desk. "I want an apology."

What she got was something quite different.

Cigna employees, looking down into the atrium lobby from a balcony above, began heckling her, she said, with one of them giving her "the finger."

Sarkisyan walked out, stunned and hurt.

"They showed me their true colors," she said. "Shame on them."

Cigna later apologized for the 2008 incident, but it has now become -- unintentionally -- the central element of a lawsuit Sarkisyan and her husband, Grigor, are pressing against the health insurer.

The suit began as a wrongful-death complaint, with the couple contending that Cigna's refusal to cover the transplant led to Nataline's death Dec. 20, 2007, in a case that drew national media attention.

A Los Angeles judge threw out the wrongful-death complaint, saying it was barred by a 1987 U.S. Supreme Court ruling that shields employer-paid healthcare plans from damages over their coverage decisions.

But U.S. District Judge Gary Allen Feess said the Sarkisyans could pursue damages for any emotional distress caused by the Philadelphia incident.

The ruling was bittersweet for the Sarkisyans and patient advocates, who say it points to the need for federal legislation to allow people to sue health insurers for the life-or-death decisions they make.

"They kill a beautiful 17-year-old girl, and I get to go after them for a finger? That's sick," Hilda Sarkisyan said.

The Sarkisyans contend that Cigna improperly refused the transplant that Nataline's UCLA physicians said at the time was urgently needed to save her life, and that the company reflexively issued a denial letter without looking into the specific circumstances.

The company said at the time that, for Nataline, the operation would have been experimental and was not covered. Nine days later, amid a storm of publicity, Cigna agreed to cover the transplant.

It was too late. Nataline died hours later.

read the full article.

While it's true that you can't sue for wrongful death if the insurer was operating under an ERISA covered plan, ERISA does allow the federal government to seek civil penalties against the insurer if benefits were improperly denied and ERISA provides no protection for individuals who denied those benefits with criminal intent, to defraud, for example, so when lawyers and would be plaintiffs argue that ERISA sets insurance companies free to deny benefits without suffering penalties for it, this is simply not true. In this case, either the liver transplant was properly denied under the terms of the insurance contract or the federal government has been negligent in pursuing appropriate penalties against the insurance company.

It may seem heartless to deny this benefit even if it was not covered by the insurance contract, as the company claimed, but Medicare and Medicaid, as well as any other government run health care system, routinely refuse claims because the service is deemed experimental or otherwise not covered by the government plan.
 
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I feel for the parents, but for them to claim the insurance company "killed" their daughter is bullshit. The child had recurrent leukemia and multiple organs were failing. The disease killed their daughter, not the insurance company.
But didn't the insurance company have an obligation to give their daughter that shot at life by paying for the procedure that could prolong her life? Or is it the insurance companies right to say she's going to die anyway why waste the money?

Seems that Cigna did say they would pay for it,
Does Cigna Deserve All The Blame? - Forbes.com
snip,
On Thursday, Dec. 20, 150 nurses picketed Cigna. Many more called the company. Later that day, Cigna contacted Geragos and UCLA to say it was making a one-time exception to the process and would cover the treatment. Though the company still believed it was experimental, it would pay out of its own pocket (not that of Nataline Sarkisyan's mother's employer) for the procedure.

Aw, how empathetic of them. It only took prominent doctors appealing the decision, the nurses' union protesting and picketing them and a cut-throat lawyer to make them see the error of their ways.

"Pay out of its own pocket" my ass. Who the fuck do those bastards think puts the money in their goddamned pocket?

Give me a break. I'm already feeling queasy this morning, this shit makes me want to puke.

It was turning into a public-relations nightmare. THAT is why they decided to pay for the transplant. If Forbes and Cigna want to defend their greed, defend their cold-hearted business decisions to protect their bottom line and keep their stockholders happy, whatever the fuck they want to do ... but they should NOT try to paint this as Cigna reaching out to help this child by the goodness of their collective corporate heart. Because that is utter bullshit.

Sarkisyan's four UCLA doctors immediately wrote back to Cigna, appealing the decision. They argued Sarkisyan would have a 65% chance of surviving for six months after the liver transplant, based on studies of similar patients. The doctors reckoned Sarkisyan had an 85% chance of avoiding a recurrence of cancer because of the successful bone marrow transplant.

Cigna hired an oncologist and transplant surgeon to review the appeal but never reversed its clinical decision.

Soon the California Nurses Association, a powerful union lobby, got involved. It joined Sarkisyan family and friends in protesting Cigna's decision. On the Dec. 19, the nurses announced a march on Cigna's Glendale, Calif., offices.

The family also hired a lawyer, Mark Geragos. Geragos is known for representing singer Michael Jackson and convicted murderer Scott Peterson. The Sarkisyan family knew Geragos as a fellow Armenian-American who had helped raise money for an Armenian bone marrow bank.

On Thursday, Dec. 20, 150 nurses picketed Cigna. Many more called the company. Later that day, Cigna contacted Geragos and UCLA to say it was making a one-time exception to the process and would cover the treatment. Though the company still believed it was experimental, it would pay out of its own pocket (not that of Nataline Sarkisyan's mother's employer) for the procedure.
 
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They gave a distraught, obviously grieving mother the finger?!

Lock the doors and burn the fucking building down.

Take the CEO and hang him in the public square.

What corporate arrogance!
 
Aw, how empathetic of them. It only took prominent doctors appealing the decision, the nurses' union protesting and picketing them and a cut-throat lawyer to make them see the error of their ways.

"Pay out of its own pocket" my ass. Who the fuck do those bastards think puts the money in their goddamned pocket?

Give me a break. I'm already feeling queasy this morning, this shit makes me want to puke.

It was turning into a public-relations nightmare. THAT is why they decided to pay for the transplant. Defend their greed, defend their cold-hearted business decisions to protect their bottom line and keep their stockholders happy, whatever the fuck you want to do ... but do NOT try to paint this as Cigna reaching out to help this child by the goodness of their collective corporate heart. Because that is utter bullshit.
I'm not defending anybody. I merely posted some more facts about the case.
 
Aw, how empathetic of them. It only took prominent doctors appealing the decision, the nurses' union protesting and picketing them and a cut-throat lawyer to make them see the error of their ways.

"Pay out of its own pocket" my ass. Who the fuck do those bastards think puts the money in their goddamned pocket?

Give me a break. I'm already feeling queasy this morning, this shit makes me want to puke.

It was turning into a public-relations nightmare. THAT is why they decided to pay for the transplant. Defend their greed, defend their cold-hearted business decisions to protect their bottom line and keep their stockholders happy, whatever the fuck you want to do ... but do NOT try to paint this as Cigna reaching out to help this child by the goodness of their collective corporate heart. Because that is utter bullshit.
I'm not defending anybody. I merely posted some more facts about the case.

Ok. Sorry for the rant. I sincerely apologize if I misunderstood your post. I edited out the reference to "you". I just vented in another thread btw.

I'm going to back away from this topic for now. I'm not in the mood to get in a bad mood ;)
 
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Buying health insurance has NEVER meant that they will pay for everything possible to ensure that you have a long nor healthy life. It's a security racket that people fall for.
That's why for-profit health insurance should be illegal.
 

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