How the Insurance Industry Killed a 17-yr Old Girl – OR – Why are Insurance Corporations Making Our Treatment Decisions and Not Our OWN DOCTORS?

When I discovered the tragic story of Nataline Sarkisyan, I was stunned, heartbroken, and very disppointed in both the American insurance industry and our government.NatalineSarkisyan

Young Nataline Had Leukemia

In 2004, thirteen-year-old Nataline Sarkisyan was diagnosed with leukemia. This would mark the beginning of a long series of arduous medical treatments and stints in the hospital for Nataline, until her tragic and untimely death less than four short years later.

Nataline was a model teenager. She attended Bible School and prayed with her mother every night. She enjoyed learning about her Armenian heritage and volunteered her time to teach other children about their Armenian-American culture. She was also a Girl Scout, sworn to uphold the Girl Scout oath, to “serve God and my country, and to help people at all times.”

All in all, Nataline was a sweet, pleasant, kind young American girl, and the world was a better place with her in it.

Nataline Was Denied the Life-Saving Treatment She Desperately Needed

Although Nataline had beat her first bout with leukemia at age 14, the leukemia made a resurgence after her 16th birthday. Her doctors told her mother that she would need chemotherapy and a bone marrow transplant. Despite the bad news and not feeling well, Nataline remained positive and smiling.

Luckily, Nataline’s brother was a perfect match for her bone marrow. The transplant was successful, but Nataline’s liver became weakened by the chemotherapy.  Sadly, her doctors were now recommending a liver transplant.

Her family waited on pins and needles, hoping an appropriate liver would become available in time. They were elated when doctors found a match within only a few days. Nataline was going to be okay!

However, what the Sarkisyans didn’t know is what would untimately kill poor Nataline. Although their health insurer, CIGNA, had initially approved Nataline’s transplant (meaning that CIGNA would pay for it under her medical coverage), they were about to change their minds.

Why Would an Insurer Deny a Young Girl Her Chance at Living a Full Life?

While Nataline was waiting for a liver, she became very weak and developed a lung infection. Upon hearing the news that Nataline was struggling, the medical director at CIGNA, who had never laid eyes on Nataline, reversed the initial decision. CIGNA would no longer cover Nataline’s life-saving transplant.

The medical director reasoned that because the results of Nataline’s transplant were uncertain (aren’t the results of all transplants uncertain?), it would be categorized as “experimental and unproven.” There was a clause in Nataline’s medical policy excusing CIGNA from the responsibility to pay for “experimental or unproven services”.

But Nataline’s own doctor had recommended the liver transplant, and it was far from an experimental surgery. So why would a CIGNA employee in another state contest the recommendation of Nataline’s own doctor? The short answer: Because the surgery was expensive and CIGNA didn’t want to pay for it. (Surgery cost = $250,000)

CIGNA Recanted, But it Was Too Late…

According to Wendell Potter, former Public Relations Executive for CIGNA, the media backlash about Nataline’s desperate situation caused CIGNA to reconsider its denial and ultimately reverse the decision. However, it would be too little, too late. Nataline passed away before she could receive the transplant.

How Could This Happen?

Although there were many contributing factors, what set the stage for this tragedy was the dynamics of the American health insurance industry. Put quite simply, because the American health insurance industry is completely rooted in free market principles, Americans are forced to make decisions between the drive for more money (more income for the private corporate insurers) and whether people “deserve” to receive benefits and be healthy (and ultimately, even whether they deserve to live, as in Nataline’s case). I’ve addressed this more fully in other posts (also see link below).

The other major cause of Nataline’s unitimely death is the unfortunate practice of allowing doctors employed by insurance companies, who have never once met with the patient, to make the patient’s treatment decisions.

Shouldn’t Our OWN Doctors be Making Our Treatment Decisions?

I am no doctor, but I think anyone possessing any shred of logic knows that the human body is endlessly complex, and every body is unique. We are each born with our own set of genetic predispositions to certain illnesses, and we are each subject to vastly different living environments. In turn, those living environments have the potential to either boost our strength or, unfortunately, cause us additional health problems. Also, the better a doctor knows his or her patient, the more accurate a diagnosis will be.

This is all really common sense, but at some point it became entirely acceptable to overlook the obvious. In the United States, doctors at large insurance corporations are regularly making life-altering medical decisions for patients they have never set eyes on, and as you can imagine, often with tragic consequences.

“Shouldn’t these doctors be held liable for medical malpractice?” you might ask. The “legal” answer is “Not in this situation, because they are merely making an insurance coverage decision. Their denial of insurance coverage isn’t a denial of treatment.” Of course this ignores the plain, obvious fact that the vast majority of patients who are denied coverage cannot otherwise afford to pay for the treatment. Effectively, denial of coverage is denial of treatment.

While I would not condone holding doctors employed by insurers liable for malpractice, as I think that would go too far – I would like to see these deadly flaws of the American health insurance system addressed, and before too many more innocent people fall victim…

To read more about Nataline Sarkisyan, visit the webpage of her Foundation.

To read more about how CIGNA denied her claim, read Wendell Potter’s book Deadly Spin.

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