HMOs

Eric5273 · #1 12-21-2007, 05:21 PM

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.

Wagner · #2 12-21-2007, 06:22 PM

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....

Eric5273 · #3 12-21-2007, 07:11 PM

Quote:

Originally Posted by Wagner

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....

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.

Wagner · #4 12-21-2007, 08:11 PM

Quote:

Originally Posted by Eric5273

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.

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)

Eric5273 · #5 12-22-2007, 12:06 AM

Quote:

Originally Posted by Wagner

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.

Wagner · #6 12-22-2007, 08:32 AM

Quote:

Originally Posted by Eric5273

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.

So you want the GOVERNMENT to dictate what operations you can and can't have? Man have you ever been sick? A close family member of mine had cancer and was refused a drug, legal in Germany, because the FDA didn't approve of it yet. The drug stopped all symptoms from chemotherapy that cause skin ulcers. Yeah, go government...love to have them involved with their religious methodologies in medicine. You can NOT open that door. A government is not a cure-all for societies problems. I can't figure if you are exceptionally pro-government or full heartedly against it

In some cases you want powers taken away, others you want drastically increased....

tjcin1 · #7 12-21-2007, 07:19 PM

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!

MrLabGuy · #8 12-22-2007, 12:20 AM

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.

Eric5273 · #9 12-22-2007, 01:38 AM

Quote:

Originally Posted by MrLabGuy

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....

MrLabGuy · #10 12-22-2007, 02:10 AM

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.