CIGNA and the denial of a liver transplant

A firestorm over the holiday season involving a denied liver transplant in a 17-year old.

For all those who spit at CIGNA and other health insurers, I simply ask this question: What makes you so sure that this procedure would have been approved in a single-payer health system?

California Medicine Man with more coverage of the case.

Comments

DermDoc
This is at once a tragic story and wonderful topic beautifully handled by Maggie Mahar. It seems unlikely that a single payer system would cover the transplant. The more difficult questions I think are: Would the transplant have been futile care and should it have been offered in the first place? I don’t have answers.
Gasman
The insurer might have denied payment for the transplant, but they could not block the transplant.
The family, if they felt strongly about proceeding to transplant, should have met with the hospital’s financial planners and arranged a payment plan to accomodate this expensive procedure.
If it is successful then they have a daughter and a pretty good case against their insurer to get them to pay retrospectively. And if not successful, then in all probability the procedure was indeed futile and experimental.
shadowfax
I don’t know that paying privately is really a viable option. But it was clear that insurance approval was only one obstacle to this girl’s survival. Had the listing been approved, there is no guarantee that she would have gotten an organ in a timely fashion. I’ve seen many priority one patients die on the waiting list. Yes, the insurance thing may have prevented her from being listed, and we’ll never know whether it was the deciding factor. But to call it manslaughter on the part of the insurance co is silly, hyperbolic rhetoric, and nobody who says so should be taken seriously.
What gets paid for – and what doesn’t – under any system is always going to be a flash point of controversy. It’s always sad to see people die when they still are grasping at a straw. But some things aren’t justifiable economically or medically, and the system that says no, be it medicare, Cigna, or some single=payer bogyeman, will always be painted as the ‘bad guy’ in these cases.
The Medicine Man
In fact, I asked the question about whether a socialized health care system would be more inclined to have approved this transplant and did some rough calculations here. Read the last point of this post. I’m pretty sure that in Canada and the U.K. she’d have been less likely to have received a liver transplant than in the U.S.
John
CountyRat
Just a small correction: it is incorrect to say that the insurance company “denied liver transplant in a 17-year old.” Insurance companies do not perform medical procedures, nor do they post armed guards at the doors of operating rooms to prevent doctors from performing them. Insurance companies make decisions about whether a particular procedure will be reimbursed under the terms of a written contract (called a policy). The issue was not that Cigna stopped an operation from happening (which it had no more power to do than the local crossing guard did). The doctors, hospital staff, and hospital administrators were perfectly free to perform the procedure any time they wanted to. The doctors, hospital staff, and hospital administrators denied the liver transplant because they would not be paid for it, not because Cigna stopped them (which it could not do if it wanted to).
While you are technically incorrect on this one detail, you are correct in your real point: there is, and always will be, a limited amount of everything, including the amount of work hospitals and physicians can do free and still survive. Consequently, there will always be tragic situations in which some people do not get a form of care that might have extended their life. This will happen no matter who hands out the money.
Insurance companies can only make decisions about what will be reimbursed. Government administrators, with the tremendous power and authority they possess, will do what insurance companies cannot; they WILL dictate what care can and cannot be provided. The government DOES have armed personnel who DO stop citizens from doing what the government forbids. Love to hate insurance companies? Fine, hate them all you like. However, do not expect to love a healthcare system based on governmental authority, unless you prefer having your doctor under the authority of an institution that does enforce its will with armed personnel.
GingerB
I hope that whoever gets/got that liver lives a long and happy life with it.
Beyond the insurance issue it would have been a shame to have transplanted it to a girl who had such a poor chance of surviving at the expense of someone who could be restored by it.
We like to break these things down to the issue of money because then it seems like nobody loses – after all it’s just money. But when I think of someone on the transplant list dying before another organ becomes available the loss is more real.
Anonymous
The issue of coverage is between patient and insurance company. It is not incumbent upon an insurance company to cover expensive procedures with little probability of success. The costs are passed on to you and me in the form of higher premiums. If the family desired the transplant, they should have paid for it themselves and then sorted through the coverage issue. While this may seem harsh to some, it is not fair to other insureds who are paying premiums to subsidize such procedures carte blanche. That this issue arises at all is uniquely American; in any other country death may likely have occurred with greater haste.
Anonymous
People complain that the health care system, docs in particular are greedy; yet is is these very people who will hold onto their own money so tightly as to hasten their own demise. Now that’s greed.
Anonymous
It is the continued futile care being performed in this country that is bankrupting the system. The press makes it sound like the girl was killed. Best case scenario, she may have lived 5 years. Most of which was spent in a hospital.
Anonymous
I found this blog as I was raging at my husband over John Edwards’ “concession speech” a few moments ago in New Hampshire. He politely advised he would rather hear the TV pundits reporting the outcome, so I turned on my laptop. I am so frustrated. For the tenth time, I know of, Edwards worked the “liver transplant murder” story into his speech. I am outraged that this Plaintiff’s lawyer can put such a misleading, no, FALSE, face on this story. His twisting of the facts and manipulation of the family’s grief does nothing to advance the discussion about improving health care in this country. The risk-utility analysis has served the law, and medicine, for a very long time. You would think a lawyer whose motives are as pure and altruistic as Edwards claims would have a better grasp of reality. How dare he bask in the glow of his 14k square foot house with his $200 haircuts and tell those of us trying to stretch our limited resources what to do? Also, at the risk of sounding mean, if his wife had exercised basic responsibility for her own health and welfare and undergone routine mammography which I am SURE even the most basic health care insurance would happily have covered with a modest co-pay, that the Edwards family likely would not be facing the imminent loss of a mother and wife. Thanks for letting me vent. Good health to all of you.

CIGNA and the denial of a liver transplant

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