Cigna Defends Handling of Case Transplant: Family’s Attorney Says Reversal Came Too Late.

By Rick Orlov

Questions over whether an insurance company acted properly in denying a liver transplant to a Northridge girl continued to reverberate Monday as insurance company executives said their actions have been mischaracterized.

In a message e-mailed to employees, CIGNA Health Care’s chief medical office Jeffrey Kang and president David Cordani said the company had done all it could for Nataline Sarkisyan, who died last week after twice being denied authorization for a liver transplant even though doctors at UCLA Medical Center said she could be saved with one.

Kang and Cordani said the insurer’s initial denial of the transplant was made after “we went directly to not one, but two, independent experts in the field who agree that the procedure in question, given the patient’s particular circumstances, would not have been an effective or appropriate treatment.

“Based on the unique circumstances of this situation and, although it was outside the scope of the plan’s coverage and despite the lack of medical evidence regarding the effectiveness of such treatment, CIGNA decided to make an exception. CIGNA did not reverse the clinical determination that the member’s plan did not cover the transplant. In fact, CIGNA went above and beyond the plan and offered to provide payment in the event the procedure should be completed.”

But attorney Mark Geragos, who represents the family that is planning to sue the company, said the offer to provide the transplant came only after the girl was taken off life support and moments before she died.

Nataline had suffered from recurrent leukemia since the age of 14. Her effort to get a liver transplant had become an issue driven by her family across the Internet and was taken up by the California Nurses Association as well as the Armenian community, which staged protests at CIGNA offices around the region.

Geragos said he has been inundated with complaints about the company from policyholders as well as current and former employees.

“This statement looks to me to be something that was carefully crafted by their lawyers and vetted by their crisis managers,” Geragos said. “It is nothing more than corporate mindspeak. If they had spent a portion of the money to take care of Nataline, we wouldn’t have this situation today.”

In the memo, the company officials acknowledged the public interest that has developed in the case and repeated their offer of condolences to the family.

“Transplants are an enormously complex and emotional societal issue, in particular because of the scarcity of organs and the experimental and unproven nature of some of the treatments involved,” they wrote.

“What is often misunderstood is that most health benefit plans, whether public or private, do not cover unproven and experimental treatment related to transplants or other treatments. Coverage decisions under these plans are based on the best scientific and clinical evidence available…”

Because of the threatened legal action and patient confidentiality, they said they could not discuss specifics of the case.

Funeral services are scheduled for 11 a.m. Friday at St. Mary’s Armenian Church, 500 S. Central Ave., Glendale.

rick.orlov(at)dailynews.com

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