It was four years ago today that I received a phone call from a Los Angeles TV reporter that would change my life, although I certainly didn’t realize it at the time.
The reporter said she had been told that CIGNA, the big health insurer I worked for back then, was refusing to pay for a liver transplant for a 17-year-old girl, even though her doctors at UCLA believed it would save her life and her family’s policy covered transplants.
I didn’t pay much attention to the call at first because, as chief spokesman for the company, I had received many calls over the years from reporters seeking comment about benefit denials. We took them seriously, but usually didn’t have to do more than tell the inquiring reporters we couldn’t comment substantively because of patient confidentiality restrictions. If pressed, we’d email a statement to the reporter briefly noting that we covered procedures deemed medically necessary and that patients and their doctors could appeal a denial if they disagreed with a coverage decision.
More often than not, the reporter would either drop it or do a piece that was quickly forgotten and would largely go unnoticed outside of the local media market. I assumed the call from LA would be no different.
I couldn’t have been more wrong.
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.