Activism
How does this sound: "After being bombarded by phone calls, letters, and throngs of protesters, the mayor of Los Angeles has reversed his decision to tear down a Westwood park and build a big-box retail center in its place"? Inspiring? A victory for democracy? The way things should work?
Now, replace the words "the mayor of Los Angeles" with "CIGNA Healthcare", and the words "tear down a Westwood park and build a big-box retail center in its place" with "deny a young girl the liver transplant her doctors have said she needs for weeks" and you'll actually have a true story:
Nataline had been battling leukemia and received a bone marrow transplant from her brother. She developed a complication, however, that caused her liver to fail.Doctors at UCLA determined she needed a transplant and sent a letter to CIGNA Healthcare on Dec. 11. The Philadelphia-based health insurance company denied payment for the transplant.
On Thursday, about 150 teenagers and nurses protested outside CIGNA's office in Glendale. As the protesters rallied, the company reversed its decision and said it would approve the transplant.
Less inspiring when told this way. Bbut this is how our health care system operates. Nataline died just hours after the reversal, before the transplant could take place.
Comments
I hope Cigna get's a jury verdict against them in a civil case for about $50 million (punitive damages!).
If I was the county DA, I'd bring criminal negligence and manslaughter charges against their CEO and other top executives.
If I was the Governor of Calif, I'd find a way to revolk their license to do business in the state and with the state or subordinate governmental entities.
What else could we do that would hurt? How about some fingernail pulling and waterboarding?
Does CA have capital punishment? String up a few insurance execs and this stuff will stop tout de fuckin' suite. The funny thing is, I don't think the death penalty has the least deterrent effect for street crime, but I think it would have a tremendous impact if you used it on white guys in suits.
Here in Washington, we just got the right to sue insurance companies for knowingly refusing a good claim. Until now, the most you could get from a suit against them was the amount they were already legally obligated to pay. Now you can actually claim damages.
CIGNA and other HMO's use tactics like this all the time. SICKO only scratches the surface. They deny service to patients (and reimbursement to providers), realizing that their decisions will be overturned IF the patient or provider appeals, but knowing that very often the victim of their denial will "just go away."
If I'm not mistaken, there is currently no way for a patient to sue an HMO. And the HMO can defend themselves by saying "We didn't deny care, we just didn't promise payment. It was your DOCTOR who failed to provide care." Nice.
But there is one other aspect to this case, and to this problem in general. UCLA could have performed the surgery WITHOUT Cigna "approval." Although the charges fo such surgery and after-care may exceed $500,000 (the cost to the institution is much less),
UCLA would have been in an excellent position to sue Cigna for expenses, and simultaneously mount a great PR campaign.
Also, if a patient has a medical emergency, physicians and hospitals are required to provide care regardless of insurance coverage, which could have given UCLA additional justification for performing the procedure and then going after Cigna for payment.
I'm not blaming UCLA for this patient's death, and obviously I know none of the clinical details. It just seems that a more proactive coalition of hospitals, physicians, the public and insurance regulators needs to be developed to prevent such disgraceful, dishonest, and murderous behavior on the part of Cigna and other HMO's.
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