For me it was particularly heart wrenching as it forced me to look back and remember the passing of my then 17 year old nephew Craig. It started with an auto accident on 5/22/01, 2 days later all us flew to St Louis when the last ditch effort to save him was to put him into an artificial coma in hopes he would survive. The next 10 days were the most tear ridden days filled with helplessness that we have ever endured. In the end we lost him. I can fully understand the loss Nataline’s parents are facing as they prepare to bury their child.
As this played out in the media it raised a lot of questions and concerns. I was bothered that what we were getting was stirred by California Nurses and had their bias. Having lived through a similar loss I kept wondering why the parents didn’t do what was needed right now rather than wait for an insurance decision? I know that my sister and brother-in-law did what ever was needed right then to try and save him, worries about insurance came after. We are not a family of means but the cost was not the issue, doing what was needed right now was.
I got an interesting email from a very close friend who happens to work CIGNA on the 21st. More, including his email after the jump.
As a little preface he wanted to make it clear he was not involved in this particular claim or the decision process, he doesn’t even work in the claims department. What he had to share was his own observations within CIGNA at the time this was unfolding. He did also ask, and I promised, that his identity would not be made known as he didn’t want it tracked back to him.
What he does offer is some insight and balance as to what we were getting in the media. This isn’t an official CIGNA statement rather one employees observations. The news clip he references is HERE and prompted him to write me as it was missing facts and misrepresenting facts. He wrote:
I’m not posting anything online for fear that it could someday be traced back to me, but if you’d like to hear my side of it:
1) video clip has major inaccuracies…
( by the way, I was at work in glendale, when the protestors were there, so i saw it first hand)
2) at cigna only a doctor can deny coverage – not a ‘bean counter’. in fact this case received the highest level of review at CIGNA, meaning the chief medical officer reviewed it.
3) insurance companies are not in the business of funding reseach or experimental treatments… so when stuff like this happens it is denied, pursuant to an appeal process, as it should be.
4) the family was pursuing the appeal process… while the ultra liberal California Nurses Association decided to exploit this family’s’ tragedy in order to criticize the governor’s healthcare plan.
5) it is not based in fact to say that CIGNA reversed it’s coverage decision based on media pressure. There are reversals that happen all the time as per the normal appeal process – sometimes based on changes to clincial evidence that happen (which is the real story behind the ‘Sicko’ issue with CIGNA) or because the doctors feel that the choice is the right one…. in this case, i think it was clearly a disastrous case… with no hope of survival, but they changed their mind as an exception to show that they do care about people’s quality of life. note i’m not an official spokesperson, that’s just my secret opinion.
6) giving someone who is in a coma a liver transplant has not been shown with adequate evidence to be medically approrpriate…
7) as such it wasn’t Cigna’s responsibility to cover this, and that still remains their position if you read the full statement
8) the family could have pursued the procedure at their own expense, or through other charitable funding, or through a deal with the hospital.
9) just because there was a delay… doesn’t mean that it would have made any difference. you can’t just order a liver transplant and have it in a few hours. Soemtimes people wait months or more than a year to receive a needed transplant. Don’t know the facts in this case, but it’s unlikely that she would have received a transplant in time to even remotely having the chance of affecting anything… clearly she could not last long and for some reason the family decided to take her off life support instead of pursuing the transplant.
10) not a single doctor has been quoted in any article or video clip in this entire media frenzy, and yet the entire argument is over medical necessity. So who are we to decide?”.
Having worked in insurance I do know that people buy insurance without really understanding what it covers and have the expectation that everything is. I wasn’t there with that family and won’t even second guess what influenced their decisions as the horror unfolded. There you go, food for thought. A little view from within to balance the views presented elsewhere.