Health Insurers Feel the Pressure of Public Protests, Bad Press When Treatment Is Denied

By Fran Lysiak
BestWire
April 7, 2008

Outraged by the decisions of for-profit health insurers that sometimes deny coverage for medical treatment, protesters who take their case to the media are recently finding success.

The bad press can lead to the insurer deciding the negative publicity isn't worth the expense, said Rick Mayes, associate professor of public policy at the University of Richmond: "They can make these changes on decisions on a whim -- and the public knows that," he said.

Two recent high-profile cases occurred in California. The California Nurses Association/National Nurses Organizing Committee, which says it's the largest union of registered nurses in the United States, was heavily involved in sponsoring or helping to organize massive public protests of PacifiCare and Cigna Corp.  Enhanced Coverage Linking

Cigna Corp. over their decisions to deny coverage for medical treatments or procedures for two very sick teenagers.

Bad Press Forms Perceptions

With the presidential candidates talking about health care as a top agenda issue, news stories -- including bad press about health insurers -- inevitably will continue, said Harlan Loeb, managing director of FD International, a public relations and crisis-communications consulting firm. Corporate decision-making and corporate policy is profoundly influenced by the perceptions of the American public because the information sources feeding to the public today, whether traditional media or new media, are powerful, he said.

PacifiCare reversed its denial of specialized radiation treatment for Nick Columbo, a 17-year-old who's suffered from a rare form of cancer in his tailbone, according to reports. Its reversal came the night before the planned protest at PacifiCare's headquarters in Cypress. But the rally proceeded as planned as Nick's family and friends wanted to see the company's decision to approve in writing. Addressing the TV cameras, PacifiCare spokesman Tyler Mason promised to do so.

Nick's doctors at Children's Hospital in Los Angeles reportedly called the advanced radiation treatment, known as Cyber Knife, his best chance of controlling the disease and his parents found a doctor in Kansas City who could perform the procedure, according to reports. PacifiCare's medical reviewer denied coverage, the CNA said. The California Department of Managed Health Care also denied the family's appeal. The Cyber Knife treatment, which could cost up to $100,000, can be effective, but doctors at Stanford University also concluded Nick was at risk of infection because his tumor was very close to his skin, according to reports.

"PacificCare and the state's refusal of Nick's cancer treatments -- overruling urgent appeals of an array of doctors and nurses -- is indicative of the failures of the health care plans offered in many states, including California," said Geri Jenkins, an elected member of the CNA/NNOC Council of Presidents, in a statement. CNA/NNOC advocates nonprofit, universal, single-payer coverage in the United States.

Mason denied the media played any role in the company's decision. The company, he said, sent out the case to medical experts at Stanford and USC but both concluded Nick wasn't a good candidate, he said. PacifiCare then sent it to DMHC for expedited independent review and their experts came back the same way, Mason said.

"The timing was such that when our doctors and a lot of our physicians looked at it and said 'this is a very difficult situation for this family regardless, and if there is a doctor in Kansas, and we're part of UnitedHealthcare, and that doctor is, even if he wasn't and wants to treat it, we'll support the family's decision' because...for this poor guy, the options either way are not good," Mason said.

Cigna Touched by Teen's Case

The other case, which attracted the attention of national print and television news, was the case of Nataline Sarkisyan, 17, who battled leukemia. Cigna initially denied coverage for a liver transplant, saying it was "experimental." But during the protest on Dec. 20 at its offices in California, Cigna reversed and agreed to cover the procedure. Several hours later, Nataline died.

The company "made its decision out of empathy for the family and the unique circumstances of this case," a Cigna spokeswoman said.

In a Dec. 31 statement, Dr. Jeffrey Kang, chief medical officer of Cigna HealthCare, said in this case, "the clinical determination included both internal and independent external review by physician transplant experts, who concluded that this procedure would be unproven and ineffective in this situation and therefore experimental and not covered under the patient's health benefit plan."

Experimental treatments, Kang said, "are a complex societal issue for which there is no easy answer. Virtually no health plan -- public or private -- provides coverage for treatments that are considered unproven or ineffective, and therefore experimental, by the medical community."

The case involved a self-insured employer, not Cigna, that pays for all clinical procedures and related care, Kang also noted.

Health insurers are feeling the public pressure "in a way they really haven't before," said Peter Harbage, senior fellow with the Center for American Progress, a Washington, D.C.-based think tank. It's "too bad that what it takes is this kind of spotlight for them to render decisions that presumably they should have rendered in the first instance."