Nataline Sarkisyan had been diagnosed with leukemia just weeks before her 14th birthday in 2004. Initial treatments were successful and the cancer went into remission. It came back two years later, however, and this time was more difficult to treat. She eventually had to have a bone marrow transplant, which CIGNA covered, but there were complications that damaged her liver. Her doctors felt, however, that she had better than a 60 percent chance of surviving five years or longer if she had a transplant.
Nataline’s parents didn’t realize it but, even though their policy covered transplants, her doctors had to get what is referred to in the insurance business as “prior approval” before going forward with the surgery. This means they essentially have to convince the insurer that the procedure is medically necessary — and appropriate.
[...] The doctors said they felt they could persuade CIGNA to give the needed “clearance” if they provided additional documentation about Nataline’s health and suitability for the transplant. They were wrong. A CIGNA medical director 2,500 miles away said he did not agree with Nataline’s doctors and felt the transplant would not be appropriate, that her chances of survival, in his opinion, were not as great as her treating physicians believed.
The Sarkisyans decided to try to shame CIGNA into covering the transplant and enlisted the support of the California Nurses Association and friends in the Los Angeles Armenian community. They were able to generate media interest in the case far beyond anything I had ever experienced before. That call from the LA TV reporter was the first of hundreds my staff and I would ultimately receive over the next few days.
The pressure worked. CIGNA agreed to cover the transplant at an estimated cost of $250,000 on December 20, 2007. Grigor and Hilda and their friends and families were overjoyed.
The Christmas joy was short-lived, however. So much time had passed since the original request was made that Nataline’s health deteriorated to the point that she was no longer eligible for the transplant. She passed away just hours after CIGNA told the Sarkisyans it would pay for it. Five days before Christmas. When Nataline died, so did any desire I had to continue as a spokesman for the insurance industry. It certainly was not the only reason I left my job, but it was the final straw. I simply didn’t have it in me to handle the PR around another case like Nataline’s.
