CIGNA health service company responded to Dateline NBC's questions about delaying the life-saving liver transplant of Nataline Sarkisyan, a 17-year-old who died of leukemia, with the following statement:
Mr. Sarkisyan's self-insured employer was responsible for all costs associated with treatment. As in more than 80% of CIGNA's business, we were acting as administrators for a self-insured employer. CIGNA, as the administrator, had no financial stake in the coverage decision.
Notwithstanding the type of health plan, CIGNA makes all coverage determinations on the basis of the best available medical evidence, regardless of cost.
In this instance, the determination that the Sarkisyan's health benefit plan did not cover the procedure was due to the fact that the procedure was unproven and ineffective in these circumstances. That judgment relied on the opinions of two independent experts as well as transplant guidelines established by the medical community.
There is no health insurance plan, even with health care reform, public, private or internationally that would cover unproven transplants, due in large part to the overwhelming demand and limited organs available for transplantation.
