HMOs
 

As we have had the debate over our health care system before, what do others propose we do to fix the many such cases like this where insurance companies deny coverage?

http://ap.google.com/article/ALeqM5h...CioSwD8TM1FCO0
Lawsuit Promised in Transplant Case

LOS ANGELES (AP) — The family of a 17-year-old girl who died hours after her health insurer reversed a decision and said it would pay for a liver transplant plans to sue the company, their attorney said Friday.

Nataline Sarkisyan died Thursday at about 6 p.m. at the University of California, Los Angeles Medical Center. She had been in a vegetative state for weeks, said her mother, Hilda.

Attorney Mark Geragos said he plans to ask the district attorney to press murder or manslaughter charges against Cigna HealthCare in the case. The insurer "maliciously killed her" because it did not want to bear the expense of her transplant and aftercare, Geragos said.

Nataline had been battling leukemia and received a bone marrow transplant from her brother. She developed a complication that caused her liver to fail.

Doctors at UCLA determined she needed a transplant and sent a letter to Cigna Corp.'s Cigna HealthCare on Dec. 11. The Philadelphia-based health insurance company denied payment for the transplant, saying the procedure was experimental and outside the scope of coverage.

The insurer reversed the decision Thursday as about 150 teenagers and nurses rallied outside of its office. But Nataline died hours later.

"They took my daughter away from me," said Nataline's father, Krikor, who appeared at the news conference with his 21-year-old son, Bedros.

Despite the reversal, Cigna said in an e-mail statement before she died that there was a lack of medical evidence showing the procedure would work in Nataline's case.

"Our hearts go out to Nataline and her family, as they endure this terrible ordeal," the company said. "CIGNA HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant."

In their letter, the UCLA doctors said patients in situations similar to Nataline's who undergo transplants have a six-month survival rate of about 65 percent.

District Attorney spokeswoman Sandi Gibbons declined to comment on Geragos' planned request for murder or manslaughter charges, saying it would be inappropriate to do so until Geragos submits evidence supporting the request.

One of the doctors, Robert Venick, declined to comment on Nataline's case when reached at his office Friday.

Blame the hospital too, if they knew it was in the patients interest and that of life, to do the transplant, they should have done it on their dime. However, they didn't did they? So much for that whole doctor oath thing.... :rolleyes:

Obviously you can blame whoever you want.

But I was asking what changes should be made to the health care system so that this sort of thing would never happen?

BTW, I'm pretty sure there is no current law requiring a hospital to perform an $250,000 operation on someone for free even if they are dying and the operation will save their life.

I know this a serious post, but if I may, I'd like to add a little humor.

Three men pass away and appear at St.Peter's gate to await their fate. St Peter asks the first man why he deserves to be in heaven. His reply is: St Peter, I am a defense lawyer and I have helped many people who could not afford my services and have not charged them. To which St Peter replies, let me see what God thinks. A few minutes later, St Peter returns and tells the man he can go to heaven.
St Peter asks the second man why he deserves to be in heaven. His reply is " I was a missionary in impoverished countries and have dedicated my life to helping people." Again St Peter goes and asks God and the second man is also granted access to Heaven.
St Peter asks the third man why he is deserving of access to Heaven. His reply is, "I am the man who came up with the HMO." Again St Peter goes and asks God. He comes back and informs the inventor of the HMO that God has graciously granted him access to Heaven, however he can only stay two days!

And there is no law requiring a HMO to do a surgery they deem experimental, regardless of success rate.

I guess for all the surgeries the HMO covered that saved lives, and one died, those odds aren't that bad.

Should check out why Scottie's husband had to wait 12 months to have a knee operation that is routine in the US....(http://www.xoutpost.com/410840-post13.html)

The answer is that the insurance companies should not decide themselves what they will and will not cover. There should be laws that decide that. The insurance companies can decide what they will charge for insurance, but there should be clear guildlines as to what they will and will not cover. The problem is that most people are not medical experts, so they don't know what sort of items they will need covered until it's too late and their policy does not cover what they need done.

As for Scottie's husband, is he still alive? Obviously it is terrible that he had to wait, but in the case of this girl, she died while waiting.

I know Eric...Let's all pay another 70% of our income in taxes and have the government run the health care system. We all know what a good job the government does when it puts their minds and our taxes to work. Just look at the DMV. She would have died waiting in line behind all the people with Hepatitis C from IV drug use and Cirrhosis of the liver from binge drinking.

Or we can pay the insurance companies an extra $2,000 a month to get everyone covered for everything.

It was a sad case indeed but your idea of a solution scares me more than the prospect of having an HMO. Oh yeah...I have a PPO and a Medical Savings account...Pre Tax.

Well, as I said, I'm open to hearing an alternative solution that makes sure this kind of thing does not happen.

And just to be clear, I can accept that mistakes are made sometimes. But this was no mistake. This was 100% intentional. The doctors told the insurance company she needed the operation and they said it wasn't covered. Only when over 100 people protested outside their offices did they agree to cover the operation, but by then it was too late.

So let's hear how MrLabGuy would change the health care system to make sure this kind of thing never happens again. I'm sure you have some good ideas....

Well Eric you would be surprised...I would support a system that covers ALL children regardless of the procedure. I would be willing to pay extra taxes for a sensible system which served to protect those who can't protect themselves.

I won't however, support a system that covers everyone which would include Junkies, Thieves and people who don't have enough sense to take care of themselves or choose to spend their money on liquor, cigarettes and lottery tickets.

We have a responsibility to take care of our children who don't always have responsible parents.

As for everyone else...Life is a dangerous place so live and act accordingly.

The problem with HMOs is that they increase their profit by providing as little care as possible.

In the film "Sicko", one of the things shown is an actual recording of a conversation that took place in the Oval Office between Nixon and Ehrlichman in February 1971. Here is a transcript:

Ehrlichman: We have now narrowed down the Vice President's problems on this thing to one issue and that is whether we should include these Health Maintenance Organizations like Edgar Kaiser's Permanente thing

NIXON: Now let me ask you, You know I'm not too keen on any of these damn medical programs.

Ehrlichman: This is a private enterprise one

Nixon: Well, that appeals to me

Ehrlichman: Edgar Kaiser is running this Permanente deal for profit and the reason he can do it...I had Edgar Kaiser come in and talk to me about this and I went into it in some depth...All the incentatives are towards less medical care because the less care they give them, the more money they make

Nixon: Fine

Ehrlichman: and the incentives run the right way

Nixon: Not bad



The following day, Nixon gave a speech where he said the following:

"I am proposing today a new national health strategy, the purpose of this program is simply this, I want America to have the finest health care in the world and I want every American to be able to have that care when he needs it."



Perhaps the incentive should be to provide the best health care possible. I'm no expert, but I'm pretty sure that is what most doctors would do if given the chance. But instead, they must deal with insurance companies who tell then what they can and cannot do, what drugs they can and cannot prescribe, and when they must refuse care to someone.

Come up with a system that has financial rewards for those who provide the best health care, and that is a private system I would support. But so far I have seen no such system anywhere in the world. Only a profit making system which encourages as little care as possible, and a non-profit system.