DEATH AFTER A 9-DAY DELAY

When Nataline Sarkisyan's critical liver transplant was denied by CIGNA, her family launched a protest outside their headquarters that drew nationwide media attention. Only then did CIGNA reverse its decision and approve the treatment, but the nine day delay cost Nataline her life. She died mere hours after the approval came through, before the procedure could be completed. 

Her family decided to sue CIGNA. Their attorney Mark Geragos said that CIGNA "maliciously killed her" and that he hoped to press murder or manslaughter charges against the insurer. Ultimately, the family was unable to win justice for Nataline due to ERISA, a federal law that prevented them — and will stop other families — from suing CIGNA and other health insurers for refusing to pay for treatment.

DELAYS CAUSE LOSS OF LIFE

For cancer patients, delays in treatment can be a matter of life or death.  A 2022 member survey conducted by the American Society of Clinical Oncology found that 42% of prior authorizations were delayed, sometimes resulting in a “serious adverse event for a patient.” The serious adverse event was described by the oncologists as “delay of treatment” 96% of the time, “denial of treatment” 87% of the time, “disease progression” 80% of the time, and “loss of life” 36% of the time, per NBC News.

It can take weeks for insurers to approve or deny some treatments or tests. If the recommended treatment is not approved, a doctor seeking to appeal must begin the lengthy process again. 

When Tracy Pike, a husband and father of three, discovered at age 45 he had stomach cancer, the combination of surgery and chemotherapy recommended by his doctor was denied. Blue Cross Blue Shield ruled Pike’s treatment as “not medically necessary." Pike's doctor appealed. Ultimately, after a series of denials, Pike died in January of 2024. Still struggling to adapt to life without her husband, his wife Angela said: “I cannot help but go back to that month in Texas — what would have happened if he had had that surgery? Would he have lived?”

NO JUSTICE FOR FAMILIES

Nataline Sarkisyan died after CIGNA denied a critical liver transplant in 2007. Little John Cupp died in 2024 of a massive cardiac arrest after UnitedHealth Care repeatedly denied his doctor's requests for a test for blocked arteries. Both of their families sought to sue the insurers, but neither with success. Families of those who die due to denied treatments have little legal recourse.

Per ProPublica: "Cupp's daughter sued United Healthcare, EviCore, the Adena Regional Medical Center and Cupp’s doctor, accusing them of malpractice, among other allegations. Cupp’s attorney, John Markus, later decided to drop United and EviCore. Lawsuits against employer-funded health plans, like the one Cupp had with United, must be tried in federal court, where case law favors insurance companies. For instance, insurers found at fault do not pay punitive damages, only the cost of treatment." 

One reason federal courts heavily favor insurers is because of a provision of ERISA, the Employee Retirement Income Security Act of 1974. Nataline's mother, Hilda Sarkisyan, has stated that her life's goal is to repeal it so that insurance companies can be held accountable for the deaths of patients like Nataline, who should have lived.

INSURANCE CEO DEFENDS POLICIES THAT GUARD AGAINST "UNNECESSARY CARE"

A video leaked by Ken Klippenstein reveals that after the Dec 4 murder of CEO Brian Thompson, UnitedHealth Group CEO Andrew Witty defended the company’s practice of claim denials. He insisted his company’s policy of rejecting a certain percentage of claims for coverage was in the best interests of all stakeholders, and that UnitedHealth must continued to “guard against” any “unnecessary care.” 

According to ValuePenguin, a site that helps users compare insurance plans’ costs, UnitedHealth’s 32% claims denial rate is twice the industry average, a denial of nearly one in three claims.

Dr Ed Weisbart, former chief medical officer for Express Scripts, one of the largest prescription benefits managers in the US, told The Guardian, “For some people, this isn’t just an inconvenience and an annoyance and an aggravation. It’s a death sentence, and the only reason the insurance companies do that is to maximize their profits. The fact that they might be killing you is not in the equation of what they care about.”

Dr Cheryl Kunis, a board member at the Physicians for a National Health Program and nephrologist recalled how one of her patients needed a PET scan to determine if a tumor could be operated on or if it had spread. Kunis told The Guardian, “The surgeon and his office, as well as my office, spent hours on the phone. We were speaking to somebody who was sitting at UnitedHealthcare in front of a computer screen who was really not knowledgeable on the underlying medical problem or the test that we are asking for the patient to have.” After an initial denial, the patient’s appeal for the scan was ultimately approved six months later.

But by then, the patient had died.