Tuesday, December 25, 2007

17 year old with Leukemia denied payment for treatment


So many issues to bring up, where to start?

1. She had a 65% chance of living 6 months with the transplant. Does that make the transplant mandatory? What if there was another possible recipient with a greater chance of living longer and healthier? 2 out of 3 people live 6 months- I would not take those odds for me, I would for my kids.

2. Everyone is saying the insurance company should pay for every transplant. I think that these should be made on a case by case basis, with some basic criteria as a baseline. Those transplants ain't cheap, and the after care is not easy on the recipient. Remember, a bone marrow transplant from her brother caused the liver failure.

3. CIGNA did not kill the girl, leukemia and liver failure did. Cigna had nothing to do with the leukemia and liver failure.

4. One newspaper editorial said that if a doctor says a procedure is OK, then it should be covered by the insurance company. I appreciate the vote of confidence, but you don't want me to have absolute power to order treatments for you. There is too much new information with new treatments with new benefits and new side effect to just let me run amok. Most doctors, like most people in general, will chose the treatment that pays the doctor best. The pendulum has swung too far in the insurance companies' favor, but physicians still need that check to our authority.

5. The payment for the transplant was refused on December 11th. The family could have given an OK, then sought media attention to pay for it (it probably costs more than a million dollars, so it's not easy to pay for). To say the insurance company stopped the transplant is false- CIGNA decided not to pay for it. When your insurance refuses to pay for your MRI, you can still get one, you just have to pay for it.

6. What was the girl's condition at the time the transplant was denied? Was she in a coma at that time? Why isn't that part of the media story?

7. It's so sad when a kid dies. I hope the family an come to terms with the fact that she died amidst all of the legal battles.

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