Cigna denied a double lung transplant after a donor was found, leaving a mother scrambling for answers

Today, I would like you to put yourself in Carole Taylor’s shoes for a few minutes, even if just as you read this.

Last week, Taylor rushed to Vanderbilt Medical Center in Nashville for a long-awaited double lung transplant, which her doctors told her not only was medically necessary but likely the only thing that would save her life. 

The surgery was quickly scheduled when a donor became available. She had been approved by the United Network for Organ Sharing, and her insurance policy covered transplants. 

But just before the surgery was to begin, Taylor, a Nashville teacher, was informed that someone (or some algorithm) at Cigna, where I used to work, had decided that the transplant was not medically necessary or appropriate after all. And because transplants are expensive and Taylor didn’t have the cash on hand to cover the procedure, she was taken off the transplant list. The surgery was canceled.

Thanks to friends who shared Taylor’s situation on social media and reporters who began to write about it, Cigna had a very familiar change of heart.

I walked away from my job at Cigna, where I had been VP of corporate communications, over a similar case. Seventeen-year-old Nataline Sarkisyan was scheduled for a liver transplant at UCLA Medical Center in Los Angeles. But when she came to the hospital on an early morning in December 2007, the surgeons took her parents aside and told them that despite the fact that a perfect match had been found, they had to cancel the procedure because Cigna had not given them “clearance” to proceed. 

As in Taylor’s case, the denial resulted in an avalanche of negative press for Cigna. Within days, Cigna reversed the denial and told the surgeons and family the company would pay for the transplant after all. 

But days–even hours and minutes–matter in situations like this. Sadly, tragically, the donor’s liver went to another patient. Nataline got sicker. Five days before Christmas, and five hours after Cigna’s change of heart, Nataline died. 

In Taylor’s case, as USA Today reported, “Cigna had determined cancer was not an approved condition” for a lung transplant, despite the fact that lung transplants have saved the lives of other cancer patients. 

In a Substack post, Taylor, who has non-small cell lung cancer, said she had been sent home from Vanderbilt “because my insurance company, Cigna Healthcare, has now denied my claim which they had previously approved.” She went on to write:

Our healthcare system is not simply broken, it is corrupt and anti-life. When a company has the power to step in moments before a life-saving surgery and refuse coverage despite the medical experts insisting it is crucial, time-sensitive, and all other options have been carefully weighed, there is no logical explanation other than greed.”

And she is right. 

Insisting on approval in advance for often life-saving care has become even more prevalent in the health insurance business in the years since Nataline passed away. Doctors and hospitals are at long last joining patient advocates in calling on Congress to take action to keep insurers from delaying and denying medically necessary care to boost profits. 

Now imagine what Taylor and her family are going through right now. Will another donor be found in time? And if so, by then, will the cancer have spread, making her ineligible for the transplant? If so, Cigna will have saved a few thousand dollars and be able to rest assured that it will have no legal exposure because of a 1970s federal law that makes it nearly impossible for a patient or a patient’s family to successfully sue a health insurer in situations like these.

Cigna said the denial was an “error.”

“There are a number of unique circumstances in this case, and we have moved swiftly to resolve our error so (Taylor’s) transplant will be covered,” Cigna said in a statement emailed to USA Today. “We deeply regret the pain and stress this has caused (Taylor) and her loved ones.”

As someone who wrote a similar statement when Nataline died, I can assure you that Cigna’s statement last week was carefully worded (and lawyer-approved) to make sure the company’s reversal will not be seen as setting a precedent. That’s why the statement says there are a number of “unique circumstances in this case.”

Know this: For every case like Taylor’s that attracts media attention, there are hundreds every day that go unnoticed by anyone other than the patient. Or her survivors.