The case of a Northridge teenager taken off life support just as her insurance company reversed itself and agreed to pay for a liver transplant is highlighting tensions among physicians, patients and insurers over the definition of experimental procedures.
Nataline Sarkisyan's family blames their insurance company, Cigna HealthCare, for the teenager's death Thursday. A leukemia patient, 17-year-old Nataline had been in intensive care at UCLA Medical Center for about three weeks after suffering complications following a successful bone marrow transplant Nov. 21, relatives said. She was covered under the policy of her mother, a real estate agent.
Doctors treating Nataline told the family and Cigna in a letter that patients in similar situations have a 65% chance of living six months if they receive a liver transplant. Doctors had qualified Nataline for a transplant Dec. 6 and a liver became available four days later, the family said. But the transplant was not performed because Cigna had refused to approve and pay for the procedure, they said.
Cigna turned down the transplant, calling the procedure experimental because it was not supported by enough medical literature as safe or effective in such cases. The family's benefit plan does not cover experimental treatments. But this week, after receiving an appeal from the family and UCLA doctors, the company reconsidered.
Arlys Stadum, a Cigna spokeswoman, said the insurer submits all transplant requests to physicians with transplant expertise for review. Every request that is refused has been seen by at least one expert physician, she said.
In explaining the reversal, she said, "It was really just looking at how complex the decision was." Stadum said she couldn't provide more details because the Sarkisyans had not given the company permission to discuss Nataline's case. Doctors at UCLA also refused to discuss the case without family permission , but other transplant physicians said doctors and the insurer faced a difficult call.
The family mobilized supporters with the help of local Armenian groups and Eve Gittelson, an online health policy writer known as "nyceve" whose dispatches appear on the influential Daily Kos blog.
On Friday, Nataline's father and brother held a news conference, lashing out at Cigna and giving their version of the events leading up to the teenager's death.
