Cigna denied a cancer patient's lung transplant. Now the insurer says it was an 'error.'

[xocetaceans]

Cigna denied a cancer patient's lung transplant. Now the insurer says it was an 'error.'

Ken Alltucker
USA TODAY
Published 4:00 p.m. ET Nov. 24, 2023 | Updated: 11:02 a.m. ET Nov. 26, 2023


A large health insurance company said it made an error when it denied coverage this week to a 47-year-old woman as she prepared to undergo a double-lung transplant to treat her lung cancer.

The woman, Carole Taylor, was summoned to Vanderbilt University Medical Center Tuesday when the hospital found a donor match for a double lung transplant. As the transplant team prepared her for the procedure, she was informed the insurance company, Cigna Healthcare, had denied the transplant.

Instead of getting a pair of donor lungs, Taylor was sent home and deactivated from the transplant waitlist.

But following a public outcry on the social media site X and Taylor's own words describing the ordeal on Substack, Cigna Healthcare said the insurer now will cover the transplant.

. . .

Read more: https://www.usatoday.com/story/news/health/2023/11/24/cigna-denies-vanderbilt-lung-transplant-for-cancer-patient/71678533007/

However, it should be noted that this sort of situation seems to have occurred before:

Health Insurer to Be Charged With Teen's Murder
Calif. family says it will sue medical insurer delaying a lifesaving surgery.

By ABC News
December 21, 2007, 8:29 AM

Dec. 21, 2007--The family of a California teenager who died awaiting a liver transplant said they would sue the insurer whom they blame for their daughter's death.

...

Cigna appears to have reversed its decision to deny the transplant after about 150 teenagers and nurses protested outside its Glendale office Thursday. "Protestors are here, the war is here," Hilda Sarkisyan, the girl's mother, told the group hours before her daughter's death. "We have a war here."

The Sarkisyan family claims that Cigna first agreed to the liver transplant surgery and had secured a match weeks ago. After the teen, who was battling leukemia, received a bone marrow transplant from her brother, however, she suffered a lung infection, and the insurer backed away from what it felt had become too risky a procedure.

"They're the ones who caused this. They're the one that told us to go there, and they would pay for the transplant," Hilda Sarkisyan said.

...

Further information on the outcome of that attempt to address the seemingly related 2007 case in court is at this LA Times link:

https://www.latimes.com/archives/la-xpm-2009-oct-08-fi-cigna8-story.html

Note: Earlier, I had posted this mistakenly in LBN, so my apologies to those who saw it there. I was not careful with the original sourcing--MSN posted it today in accordance with its "updated" timestamp, but the story was originally published on 24 Nov 2023.


My thoughts are that simply that insurance companies harboring a profit motive should not be part of healthcare. Like education, healthcare should be available for the good of the public individually and society generally.

[DFW]

1. It's not only insurance companies with a profit motive. Bureaucrats cause the same misery.

In the home town of my wife's mom in northern Germany, a friend of theirs was involved in a serious car crash years ago. Her injuries required a very long recovery which included years of pain medication. She was immobilized for a long time, and grew obese during that time. After many years, she kicked the pain medication slowly became active again, and started to shed most of the weight she had put on over the years. This left her with large folds of unsightly empty skin, and her dermatologists recommended surgery to remove much of it. The government insurance agency denied coverage, despite what her doctors said was necessary for her to resume a normal life. She got more and more medical attests to bolster the argument that it was a medically mandated procedure, not merely a cosmetic one. She has now been denied the operation for the fourth time. Uncaring government bureaucrats can't find an appropriate number on their chart to categorize it, or something. She is now planning to get a lawyer and hold press-attended protests outside the local office of the government health agency. TV coverage of their incompetence or cruelty are the two things German bureaucrats fear more than an asteroid falling on them.

Germany, despite what many would claim, does not have universal health insurance coverage, but rather has a patchwork quilt of companies and agencies that cover patients as they see fit. It must be requested, unless you are employed within Germany, and the employer offers it automatically. Several hundred thousand fall through the cracks and have no health insurance at all. I've seen the paperwork, since my wife is a German social worker. When she took early retirement at age 60, I had to step in to the tune of €550 a month for her health insurance until her age 65 government mandated senior health insurance kicked in. It is still the "second class" health insurance that most Germans have, and she sometimes has to wait months for an appointment. She is going nuts right now, trying to get the agencies to care for her mother, who is age 96, and can no longer see. I haven't even bothered with German health insurance. I asked for a quote in 2011, and was quoted €30,000 (currently about $33,000) a year--and even then, THEY decide if they'll cover what I submit or not. I doubt the rates have gone down since then, but I haven't asked.

[xocetaceans]

7. I'm sorry to hear of the bureaucrat-originated difficulties that your wife's mother's friend is having and of ...

... the flaws in the German system that are affecting you and your family. I hope that you are able to get care for your wife's mother.

(I have only ever had tangential involvement with the German healthcare system/system of insurance--I had coverage with AOK back in the 1980s but (being fortunate and young) did not ever need to use it. The most memorable thing that I took away from my contact with AOK was that the AOK main office had an architecturally interesting, vertically oriented conveyor belt which functioned as an one-person elevator between floors. As elevators go, it was pretty minimal and quite unusual in my experience.)

[DFW]

8. We yell and scream and battle with the bureaucrats all the time.

We're used to it, but what really frustrates me is hearing from Americans who speak not a word of German, have never lived here, and have no earthly clue about what it's like here, telling me about how everything is free here and how Germany has universal health care. They must believe in the shmoo.

If I want fairy tales, I'll pick up a compilation of stories by Hans Christian Andersen.

[xocetaceans]

9. Yes, it's certain that no system is perfect.

That being said, whenever I have returned to Germany, it always had the feel of a home away from home. It was a true gift (only in the English sense of the word--I won't echo Mark Twain's sentiments) to be able to learn the German language.

[DFW]

10. Europeans in general seem to tend to make things more complicated than is necessary

They make up ten rules for everything and situation, and then hire twenty bureaucrats to enforce them. It keeps the. DD ir budget deficits and taxes up, and unemployment down. The Prussians and the French were masters at this, and the rest of Europe seemed to think it was a great idea.

[Silent Type]

2. To be fair, lung transplants are seldom recommended/approved for lung cancer patients.

This was an extremely rare situation.

[dalton99a]

3. There should be a special rung in hell for health insurance corporate executives and their whores in Congress.

[Skittles]

5. yes

I could not do that job, I think one would have to be a sociopath

[moniss]

4. The mission of doctors and medical staff

is to provide healthcare. The insurance companies commandeered the whole matter not for the purposes of providing health care but for the purposes of providing profit by limiting cash out versus money paid in. They will limit the cash out by any means they can and they will maximize the money in by whatever they can get away with.

[area51]

6. Sadly this is going to continue to happen

unless we convert to universal healthcare.