The insurer defends its initial denial of a liver procedure for a teen who died last week.
A Friday funeral was set for the Northridge teenager who died last week after her insurer refused to pay for a liver transplant and then reconsidered. Meanwhile, the girl's health plan stood by its initial decision Monday.
Philadelphia-based Cigna HealthCare has a record of approving coverage for more than 90% of all transplants requested by its members, as well as more than 90% of the liver transplants, company President David Cordani said in a memo addressed to employees and distributed to members of the media.
Nataline Sarkisyan's request was evaluated on an expedited basis using "evidence-based guidelines published by independent physician and medical organizations, as well as expert scientific journals," Cordani said.
...
UCLA doctors put her on a list for a liver transplant Dec. 6 and a liver became available four days later, the family said. Her doctors told Cigna in a letter that patients in similar situations had a 65% chance of living six months if they received a liver transplant.
But the transplant was not done because Cigna deemed it experimental in Nataline's case and refused to pay for it.
...
Cigna's Cordani said in the memo that some unspecified accusations had "mischaracterized our decisions and intentions."
"Cigna did not reverse the clinical determination that the member's plan did not cover the transplant," Cordani said. "In fact, Cigna went above and beyond the plan and offered to provide payment in the event the procedure should be completed."
A Cigna spokesman said the company could not comment further because of patient confidentiality laws and the threat of a lawsuit.
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