It was only seven moths ago that the heart wrenching story of 17-year-old Nataline Sarkysian hit the national media and stirred a potential patient revolt. Nataline was critically ill and required a liver transplant. Her health insurer, CIGNA corporation, refused to authorize payment for the procedure. Demonstrations against the insurer were organized by the California Nurses Association and the Armenian community to bring the heat of media attention upon the carrier. At the 23rd hour, CIGNA capitulated and agreed to pay for the transplant. But it was too late for Nataline. She died.
A quick study of the blogsphere shows that this is not a new or uncommon story. People who believe that have “full coverage” for any sickness or health condition find the insurance industry initially dragging their heals on providing authorization, then finding either an exclusion or making an outright cancelation of the policy on grounds of misinformation or discrepancies found in the original application for insurance.
This later practice was challenged in a class-action suit brought by the City Attorney of Los Angeles against Blue Cross of California and Blue Cross Life & Health. The lawsuit claimed that patient policies were being illegally rescinded after patients filed claims for medically necessary care.
It is now reported that the case settled for $11.8 million, subject to court approval. The money is to be used for those patients that were forced to incur costly medical bills when the carrier refused to honor their obligations.