"Cigna stated in a press release that its denial was based on “coverage guidelines grounded in national clinical standards.”"
Would a single payer/government sponsored system make a different decision than Cigna did? Would this be a no questions asked covered procedure in Canada or the UK? I wish the article was able to address that as it seems the better question rather than assuming that the result would be different because of the different model. Single payer healthcare systems deny treatments as well.
I wish HIPAA didn't stand in the way of a more robust discussion in cases like this. What were the specific criteria used? Were they fair? The article assumes they were not presumably because a "real doctor, on the ground" recommended the treatment. While I'm not giving Cigna any extra credit for fairness, are we sure Cigna was wrong here? Based on what criteria?
If one doctor suggests a procedure should that always be enough that we all pay for it? Keep in mind that doctors are people that make mistakes, have a personal financial interest in the amount of care they provide, have little motivation to consider cost on behalf of patients and insurers and sometimes aren't great at their job. Just look at the kooks that championed ivermectin as a Covid cure or all of the unnecessary treatments and testing highlighted by the American Board of Internal Medicine's "Choosing Wisely" campaign back in 2012. Sometimes the right answer is no. I am certainly not saying that's the case here though, but we're not presented with enough information either way here to tell. At the very least, it sounds like the Wells family deserved better communication and transparency.
My husband has a lung disease ( IPF) and is getting ready to go through the evaluation to see if he is a candidate for a lung transplant. The evaluation is multi day, and covers physical, social and financial. One thing we have been told is that any type of cancer would cause him not be eligible, and the transplant centers would not consider putting him on the list. My heart aches for this patient and his family, but as others have said, there is more to this discussion / decision that cannot be discussed publicly.
The only developed country with for profit health insurance. We need a robust alternative like Germany - we need national ins. Won’t happen with this present administration
So glad I live in a Civil Society where we care about the less well off and happy to pay our taxes to provide free healthcare, education etc for everyone. Good luck USA for next 4 years.
EXACTLY what I expect. Stage 4 MBC, and sadly dealing w miscreants at Kaiser Perm , Was checked in by their Urgent Care, forms, acct numbers etc , doubled in extreme pain, in wheelchair.Horrible wait for us until finally an actual dr shows up , to state must go to ER (to again ck in) as they only give aspirin there. ER SHOT ME W MORPHINE so EACH PROFIT CENTER CAN BILL US NOW.
In this instance, the insurance company may be right, as there is absolutely zero chance that Mr. Deren will survive his stage IV cancer — metastasis will show its ugly head sooner or later. Susan
No kidding. It's terrible when treatment gets denied, but the question of which treatments should be approved for which conditions/circumstances will be a problem with single payer or any system. No healthcare system, private, government supported single payer or a hybrid of some kind can afford to provide unlimited/unrestrained care.
A double lung transplant is $1.3-$2.3 million. I don't know Mr. Wells circumstances, but under what circumstances would you, the reader, say that should be covered/paid? Keep in mind that regardless of the system, you're paying it either in premium or taxes. Should it be approved if it provides a 50% chance of survival?, 20%? 10%? 5%? What's the cutoff? How do we even determine the survival likelihood to make these assessments? No one wants anyone to be denied even a small chance for a longer life, but we do have to make these decisions as a society.
When they STOP LYING to our face and making undoable promises, do you think that might help ? You're just so clueless , when we patients have no voice , they constantly call things anything but what is real . It's the drs and oncols fault ENTIRELY when not explaining future
HMMMM. SO many thoughts here. If the ENTIRE govt, hospitals, ambulances, med schools , etc would stop DUMPING drugs that are valuable and viable. Suggested expiration dates are way off, and never verified w testing or research , just BIG PHARMA ( profit incented ) provided dates. Just 1 0f a million examples of WASTE and MISUSE
This is why we need to get rid of commercial insurance and move to single pay time model
"Cigna stated in a press release that its denial was based on “coverage guidelines grounded in national clinical standards.”"
Would a single payer/government sponsored system make a different decision than Cigna did? Would this be a no questions asked covered procedure in Canada or the UK? I wish the article was able to address that as it seems the better question rather than assuming that the result would be different because of the different model. Single payer healthcare systems deny treatments as well.
I wish HIPAA didn't stand in the way of a more robust discussion in cases like this. What were the specific criteria used? Were they fair? The article assumes they were not presumably because a "real doctor, on the ground" recommended the treatment. While I'm not giving Cigna any extra credit for fairness, are we sure Cigna was wrong here? Based on what criteria?
If one doctor suggests a procedure should that always be enough that we all pay for it? Keep in mind that doctors are people that make mistakes, have a personal financial interest in the amount of care they provide, have little motivation to consider cost on behalf of patients and insurers and sometimes aren't great at their job. Just look at the kooks that championed ivermectin as a Covid cure or all of the unnecessary treatments and testing highlighted by the American Board of Internal Medicine's "Choosing Wisely" campaign back in 2012. Sometimes the right answer is no. I am certainly not saying that's the case here though, but we're not presented with enough information either way here to tell. At the very least, it sounds like the Wells family deserved better communication and transparency.
My husband has a lung disease ( IPF) and is getting ready to go through the evaluation to see if he is a candidate for a lung transplant. The evaluation is multi day, and covers physical, social and financial. One thing we have been told is that any type of cancer would cause him not be eligible, and the transplant centers would not consider putting him on the list. My heart aches for this patient and his family, but as others have said, there is more to this discussion / decision that cannot be discussed publicly.
He and the family need to SUE Cigna in CIVIL court for $$$$$$
One of the most corrupt insurance companies around 🤬
The only developed country with for profit health insurance. We need a robust alternative like Germany - we need national ins. Won’t happen with this present administration
So glad I live in a Civil Society where we care about the less well off and happy to pay our taxes to provide free healthcare, education etc for everyone. Good luck USA for next 4 years.
EXACTLY what I expect. Stage 4 MBC, and sadly dealing w miscreants at Kaiser Perm , Was checked in by their Urgent Care, forms, acct numbers etc , doubled in extreme pain, in wheelchair.Horrible wait for us until finally an actual dr shows up , to state must go to ER (to again ck in) as they only give aspirin there. ER SHOT ME W MORPHINE so EACH PROFIT CENTER CAN BILL US NOW.
deja vu:(
In this instance, the insurance company may be right, as there is absolutely zero chance that Mr. Deren will survive his stage IV cancer — metastasis will show its ugly head sooner or later. Susan
No kidding. It's terrible when treatment gets denied, but the question of which treatments should be approved for which conditions/circumstances will be a problem with single payer or any system. No healthcare system, private, government supported single payer or a hybrid of some kind can afford to provide unlimited/unrestrained care.
A double lung transplant is $1.3-$2.3 million. I don't know Mr. Wells circumstances, but under what circumstances would you, the reader, say that should be covered/paid? Keep in mind that regardless of the system, you're paying it either in premium or taxes. Should it be approved if it provides a 50% chance of survival?, 20%? 10%? 5%? What's the cutoff? How do we even determine the survival likelihood to make these assessments? No one wants anyone to be denied even a small chance for a longer life, but we do have to make these decisions as a society.
When they STOP LYING to our face and making undoable promises, do you think that might help ? You're just so clueless , when we patients have no voice , they constantly call things anything but what is real . It's the drs and oncols fault ENTIRELY when not explaining future
options.
HMMMM. SO many thoughts here. If the ENTIRE govt, hospitals, ambulances, med schools , etc would stop DUMPING drugs that are valuable and viable. Suggested expiration dates are way off, and never verified w testing or research , just BIG PHARMA ( profit incented ) provided dates. Just 1 0f a million examples of WASTE and MISUSE