Occupation Student | Name Death Nataline | |
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Full Name Nataline Mary Sarkisyan Born July 10, 1990 ( 1990-07-10 ) Los Angeles, California, U.S. Died December 20, 2007(2007-12-20) (aged 17)
Los Angeles, California, U.S. Parent(s) Krikor (also spelled Grigor) and Hilda Sarkisyan | ||
Nataline Mary Sarkisyan ; July 10, 1990 – December 20, 2007) was an American teenager with recurrent leukemia. Her case became part of the health care reform debate in the United States in 2007 when Cigna HealthCare denied coverage for a liver transplant operation. The company later reversed its decision after a great deal of media attention to her story, but Sarkisyan died hours later.
Contents
Background
Diagnosed with leukemia at age 14, Sarkisyan had health insurance coverage under the employer coverage of her parents. Physicians informed the family and insurance company, Cigna HealthCare, that patients in similar circumstances have a six-month survival rate of 65% after a liver transplant. The likelihood of success of the recommended procedure was questioned. Dr. John Roberts, chief of the transplant service at UC San Francisco (not the transplant center treating Sarkisyan), stated that his center generally does not accept a patient without a 50% or greater five year survival rate. The chief of the Baylor Regional Transplant Institute in Dallas, Dr. Goran Klintmalm, said this particular operation was a "very high-risk transplant." Dr. Klintmalm did state that he would consider the same operation on a similar patient. On December 11, 2007, Cigna rejected the request for coverage for the liver transplant. Sarkisyan's doctors at the UCLA Medical Center, including the head of its transplant unit, wrote a letter to protest that the treatment proposed was neither experimental nor unproven and called on Cigna to urgently review its decision.
Cigna HealthCare refused to pay for treatment by citing policy provisions which do not cover services considered experimental, investigational and/or unproven to be safe and/or effective for the patient. Cigna noted that it had no financial stake in the decision because it only administered the insurance plan and would not bear the cost of any operation. The cost of a liver transplant and one year of follow-up care was $450,000 in 2005. UCLA declined two livers while waiting for insurance approval from Cigna. Ms. Sarkisyan's family was also informed that they could proceed with the transplant if they could make a down-payment of $75,000.
Among the groups who publicly spoke out against Cigna's decision was the California Nurses Association/National Nurses Organizing Committee.
After public media attention grew, Cigna reversed its decision, but offered to pay for the transplant itself when it made the exception to the policy. Cigna's reversal of its policy, offering to pay for the transplant, came several hours before Sarkisyan's death.
Aftermath
Sarkisyan's family spoke out at a New Hampshire rally in support of Senator John Edwards' presidential campaign on January 6, 2008 based on his advocacy of reforming and overhauling the US health care system.
Lawsuit
Sarkisyan's family retained attorney Mark Geragos to sue Cigna, and requested that Los Angeles County District Attorney Steve Cooley file murder charges against the insurer. The case was thrown out due to a Pilot Life Ins. Co. v. Dedeaux, 1987 U.S. Supreme Court ruling shielding employer-paid healthcare plans from damages over their coverage decisions.