CIGNA Faces a Lawsuit
Cigna Employee Gives Grieving Mother the Finger
By Victoria Stein
In 2007, 17-year-old Nataline Sarkisyan needed a life-saving liver transplant, but CIGNA, her insurance company, wouldn't pay for it. Nine days later -- amid a media maelstrom and public outcry -- the company reversed its decision. Sadly, it was too late. Nataline died just hours after the decision was overturned.
In 2008, Nataline's parents, Hilda and Krikor Sarkisyan, along with members of the California Nurses Association, traveled to CIGNA's Philadelphia headquarters looking for an apology from CEO Edward Hanway. Hilda Sarkisyan told the building's security: "You guys killed my daughter. I want an apology," reported the LA Times. The Sarkisyans received an unfriendly welcome. After being denied access to Hanway, employees shouted rude remarks from the atrium balcony and one gave Hilda the finger.
CIGNA later issued a formal apology for the incident -- an incident that is now at the center of a lawsuit.
Click the arrow below to watch video about the Sarkisyans and the CIGNA confrontation. The story continues below the video.
The Sarkisyans filed a wrongful death complaint in 2008, stating that CIGNA's refusal to pay for the transplant led to Nataline's death. But a Los Angeles court threw out the case, citing a 1987 US Supreme Court ruling protecting employer-paid healthcare plans from damages over their coverage decisions.
In dismissing the wrongful death complaint, US District Judge Gary Allen Feess cited the 1974 Employee Retirement Income Security Act (ERISA), which oversees employee retirement funds and benefit plans. Under the law beneficiaries of employee-paid health plans can only sue for the cost of the treatment or service in dispute.
Because the expense of a lawsuit is usually greater than the cost of the treatment, few cases go to court, effectively protecting insurance companies from coverage disputes. The Sarkisyans, patient rights' advocates, and consumer watchdog groups want to change that. Nataline's case, they argue, illustrates why new federal legislation is critical to healthcare reform.
In an odd twist, however, Judge Feess granted the Sarkisyans permission to seek damages for emotional distress resulting from the confrontation in Philadelphia. The Sarkisyans and their supporters feel conflicted about the ruling. While it allows the family to pursue legal action, they believe changes must be made to permit people to sue health insurers for life-or-death decisions.
"I want to get rid of this ERISA law and replace it with Nataline's law," Hilda Sarkisyan said in the LA Times.
In the meantime, the Sarkisyans filed suit this month over the lobby incident. CIGNA released a statement saying that case was "without merit" and that the company expected to prevail.
Click the arrow below to learn more about Nataline's story.
The suit raises important questions about patients' rights, the decisions made by doctors and insurance companies in life-or-death situations, and a complex, confusing and difficult to navigate healthcare system. As the debate over healthcare reform continues to heat up, we decided to take a closer look at what a patient should do if denied medical coverage.
1. Review the medical claim denial carefully. There should be a denial code and an explanation of the codes, usually located at the bottom of the remittance form.
2. If the reason seems incorrect, contact your insurance company's customer service department. There should be a phone number on the form. Explain why you disagree with the claim and ask what the procedure is for getting it paid. Be nice and stay calm. If the denial was made by mistake, this person may be able to correct it for you while you are on the phone.
3. If you don't understand the reason for the denial, politely ask for an explanation. It's common for an insurance company to deny a claim because of lack of information on the claim form. Ask the representative what you must do to correct the situation. You may need to call your doctor's office and ask the billing manager to correct certain information and resubmit the form.
4. If the claim was denied for timely filing, this does not mean the insurance company will not pay the bill. Your doctor's billing office must resubmit the claim with proof of timely filing.
5. If the claim was denied for an incorrect diagnosis or procedure code, this information must be corrected and the claim should be resubmitted.
6. In some cases, it is necessary to file a written appeal to the insurance company. Ask the representative where to send the appeal. Explain in detail the reasons you feel this claim should have been paid. Save copies of all correspondence, bills, remittance forms, and notes of telephone conversations (the name of the representative you spoke with, the date, and what they said).
7. Ask the doctor's office for help. They often know who to speak to and how to address the problem.
8. If the situation is urgent, enlist the help of your doctors and hire a lawyer if necessary. Alert local healthcare worker unions and advocacy groups who may be able to take action on your behalf.
Remember, if you are not satisfied with the decision made on your medical claim, you do have recourse.
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Recent Comments
ERICHSPLACE 02:21:44 PM Oct 12 2009
One way or another the CEO will have to confront this family, with all the publicity that this will generate, Michael Moore to the rescue. This is the very reason why a healthplan for all americans has to pass, and the Democrats and the Republicans who keep holding this up, there needs to be a bipartisn watch dog group who is keeping count of the ones who are holding this up, whereas the ones who support a plan. So when reelection comes around, we know who did what. Furthermorek, I am an independent, and this hold up in congress disqust me.
DogPopo5 08:29:46 PM Oct 11 2009
KrussRN, you are incorrect. Employers do not disclose what procedures are investigational. These procedures also do not have a written non coverage policy on the insurers website. There is no fine print for these procedures that we the purchaser of services must read before signing. That is the whole point to this story. Private insurers have been denying procedures and noting that procedures are investigational for years even though the device or procedure has more then enough clinical studies and FDA approval for devices involved in the procedures. Liver transplants have been available for 30 years now. Hardly investigational.
KRUSSRN 06:41:29 PM Oct 11 2009
(finally the end) Malpractice insurance costs will always be passed on to consumers, just like costs for anything else is passed on to the consumer of that particular commodity. **We can't lose sight of all common sense by "throwing out the baby with the bath water." There ARE better ways to get a handle on these seemingly out-of-control medical costs. It CAN be done without rewriting our constitution or compromising our moral principles..
KRUSSRN 06:40:30 PM Oct 11 2009
(finishing)6. There were other options this family could have taken, but either chose not to do so or failed to be informed about what their options actually were. Either way, even though I agree that insurance companies are FAR from perfect, they are not to blame for every negative outcome. People are born, we live our lives the best we know how (most of the time), and we die (some sooner than others). I lost my sister to ovarian cancer when she was still in her 40's. It's no one's "fault" - it's just life! 7. Public/Government-run healthcare is NOT the answer. Competition among insurance companies across state lines would help tremendously to keep insurance companies in check. Also, some kind of legislation that would restrict litigation against medical professionals would change the sky-rocketing costs of medical care in ways that nothing else ever will. Malpractice insurance costs will always be passed on to consumers, just like costs for anything else is passed on to the cons
KRUSSRN 06:36:57 PM Oct 11 2009
(trying to finish). . . it has EVERYTHING to do with those he chooses to surround himself with, his staff choices, his policies, his inexperience (as evidenced by his inability to make decisions or answer policy critics without having a week or so to have prepared speeches written for him and posted on a TelePrompTer). I'm a registered Democrat, not that my party affiliation matters. I just want what's best for the health of all Americans who expect to receive the best possible heathcare we can offer. 5. I've actually written my own personal objections directly to the ANA for falsely representing themselves to the American people as a group that represents "all nurses" -- they do NOT represent ALL nurses, in fact they represent a MINORITY of nurses (many of whom have withdrawn their memberships in the ANA because of these recent partisan announcements. 6. There were other options this family could have taken, but either chose not to do so or failed to be informed about what their opt
KRUSSRN 06:35:18 PM Oct 11 2009
(Continued)Stop exaggerating and causing panic. If in fact this did happen, it would be rare and there would definitely be legal reason to hold that hospital and/or doctor liabel. 4. Contrary to what Obama would have Americans believe, most physicians as well as most nurses are AGAINST his healthcare policies which include any sort of "public option" (government-run healthcare). Most doctors do NOT belong to the AMA (American Medical Asso.) and many if not most nurses are NOT represented by the ANA (American Nurses' Asso.) ! This is what Obama does NOT want the public to know, so much so that he actually passed out white coats to the few healthcare professionals who were invited to attend the recent propaganda fiasco on the White House lawn.Before anyone starts making any assumptions about my motives: this has NOTHING to do with the color of Obama's skin, his eyes, his hair, his wife, his children, his mother, his father, his aunt, his choice of family pet, where he vacations, . . .
KRUSSRN 06:33:37 PM Oct 11 2009
1. Workman's Compensation operates much differently than "regular" personal healthcare insurance claims. 2. Stop complaining about the coverage you do or don't have. Every employer is legally obligated to give each of their employees complete disclosure as to exactly which plan covers or does not cover which doctor fees, procedural fees, etc. READ before you sign your name, then there won't be a surprise when you get exactly what you agreed to pay for. NOTHING is FREE (even though Obama wants us to believe it is). 3. In all my years as both a registered nurse working with direct patient care and as an RN Case Manager who works as the patient's advocate with insurance companies, I have never known a doctor or a hospital to discharge a patient in danger of dying simply because there was some sort of conflict with an insurance representative. Stop exaggerating and causing panic. If in fact this did happen, it would be rare and there would definitely be legal reason to hold that hospit
KRUSSRN 06:29:44 PM Oct 11 2009
1. Workman's Compensation operates much differently than "regular" personal healthcare insurance claims. 2. Stop complaining about the coverage you do or don't have. Every employer is legally obligated to give each of their employees complete disclosure as to exactly which plan covers or does not cover which doctor fees, procedural fees, etc. READ before you sign your name, then there won't be a surprise when you get exactly what you agreed to pay for. NOTHING is FREE (even though Obama wants us to believe it is). 3. In all my years as both a registered nurse working with direct patient care and as an RN Case Manager who works as the patient's advocate with insurance companies, I have never known a doctor or a hospital to discharge a patient in danger of dying simply because there was some sort of conflict with an insurance representative. Stop exaggerating and causing panic. If in fact this did happen, it would be rare and there would definitely be legal reason to hold that hospit
danxg 04:48:24 PM Oct 11 2009
One of the biggest ironies about the left is their disgust with religion and infatuation with Darwinism. Yet the left so profoundly rejects the adoption of that theory in day to day life.I was a Democrat in my early years, then a Republican, now nothing...because both parties are full of crap....where does one go from here?
danxg 04:42:51 PM Oct 11 2009
Where are peoples self respect? How could a person ask for a hand out? I just don't get that. Has America become so fat and complacent that it expects all these entitlements? If you beg....you beg. How about a donation fund on our tax returns, those that want to give to charity, will do it. If Michael Moore donated half his earnings from capitalism, we'd get quite a few uninsured covered right now. I would help people out, as long as they don't end up suing the person trying to help them...
