As you might imagine, I'm receiving lots of emails about the death of Nataline Sarkisyan.
I'd like you to read a couple.
One of the most valuable, comes from a transplant surgeon who, as you might imagine, given what he says, asked to remain anonymous.
He describes the chilling and routine gauntlet endured by doctors and patients across America every day, at the hands of the Murder By Spreadsheet insurance industry.
Insurance companies are in the business of delivering profits to their shareholders, and multi-million dollars paydays to their executives. They do this by charging exorbitant premiums, cherry-picking applicants, denying care, and retroactively cancelling legitimate policies.
I thought it important to share this email, because there have been some questions about the decision-making process at UCLA. Until we hear all the facts, I'm going to reserve judgement.
But the bottom line remains, if CIGNA had approved the transplant when it was first requested, we would not be having this discussion.
Then remember the insurance industry business model: Delay. Deny. Deceive.
This letter should give you a sense of the unfathomable obtacles and barriers the for-profit insurance industry place against patients and their doctors in a deadly take-no-prisoners crusade to deny care and increase profits.
Dear Eve:
This is out of the insurance play book 101. My patients suffer this same fate EVERY day.
Insurers always qualify their denial letters with a sentence to the affect that the doctors must provide whatever care is necessary and that the payment is a separate issue. Insurers never deny CARE only the authorization for payment. To stall the actual delivery of care, insurers hold out an insincere promise to authorize payment if only the doctor provides more information. This leads the doctor on indefinitely, while insurers never says absolutely 'No' until the patient gives up or dies.
I agonize every day whether to wait one more day for the promised approval, or go ahead with the surgery and potentially damn the patient, their family, and the institution to assuming the insurer's responsibilities and financial consequences. If I do go ahead without approval, as I have on many occasions, the administrators in my hospital call me in to explain why so many of my patient's insurers are not paying and why am I performing surgery not approved by the insurer? No one rescues the patient and the family who face huge bills and bankruptcy.
"Experimental" is another bogus insurance industry stall tactic. In a clever deception, insurance contracts don't give the criteria for experimental. Having debated this very issue with insurers, their position is that they, and they alone, unilaterally define what is 'experimental' . Such unilateral decision-making, makes the insurer a party to a totally illegal and unsustainable contract. A valid contract bestows rights and obligations on each party. To include an undefined term invalidates the legality of this clause.
If the doctors treating Nataline can tell the family and Cigna in a letter that patients in similar situations have a 65% chance of living six months--then it is not experimental as they know the outcome. A 65% chance of living six months does not preclude a 50% survival at 5 years. Also if consent is not required by the Institutional Review Board (IRB), as part of an approved experiment--it is not experimental. If others have already reported the procedure it is not experimental. When something becomes no longer experimental, is a matter of degree that can only be decided by a clinician and individual patient.
The third predictable insurance industry stall is the 'expert' review. I am certain the insurer submits all transplant requests to physicians with minimal, if any, transplant expertise for review. I would define an 'expert' as a doctor who did a transplant or took care of a transplant patient this week. Insurers and their "medical experts" who review my denials define ANY has-been, retired, unemployed failure with a medical license as an 'expert' who is paid to deny care. This is practicing medicine without examining the patient or seeing all the data. In effect, the licensed RN and MD working for the insurer, practice medicine unprofessionally and criminally. They violate codes of ethics and should also be prosecuted and disciplined. I doubt, and so should you, the credentials of the oncologist and liver specialist working for CIGNA
Nataline was killed weeks ago, once the insurer decided to stall.
The family is within their rights to expect coverage for what their doctor determines is necessary as CIGNA (we're in the business of caring")promises in all its promotional material. Our society needs universal regulations to prevent these criminal acts.
Insurers must be prosecuted under criminal statues, and if found guilty sentenced to lengthy jail terms.
[emphasis added by nyceve]
Here's one more--from a self-described conservative.
This email was simply titled: "your diaries"
for what it's worth, I'm a Conservative who monitors Kos. Even I called CIGNA after reading your original diary. Now you may condemn me for being a champion of the forces that led to the issue in the first place (I would argue it's more complicated than that) but alas, I was moved to call because they were wrong and you brought it to MY attention too.
Tragically, Nataline Sarkisyan has become the face of our collapsed healthcare system. This day was bound to happen.
The horror remains that Nataline is but the tip of the iceberg. What happened to Nataline is commonplace business as usual in the United States.