We don't have enough livers for every transplant case; someone needs to say no to some of them. If you think that's necessarily an evil act, you need to think harder.
The issue I see with all this is the anger isn't because this CEO denied claims that should have been accepted (that would be reasonable anger), it's that they denied claims at all. How do people expect insurance to work? An insurance company that never denies claims doesn't stay in business.
(And obviously, yes, I think the US healthcare system is lousy. But in the system you have now, you have insurance companies, and they need to operate in the real world.)
> More than 100 doctors at three of the nation’s top medical centers have weighed in on her case, which is complex and exceedingly rare. Their conclusion: The only way to save Erika’s life is to give her a new liver.
> After weeks of evaluation at the Cleveland Clinic in December and January, Erika finally got her big break.
> On February 2, doctors there approved putting her on the wait list for a liver transplant.
> But Erika hit an immediate wall. Her insurer, UnitedHealthcare, denied coverage for the transplant, saying it would not be a “promising treatment.” She appealed and was rejected again.
1. It's explicitly stated, including by the doctor involved, that this is a "groundbreaking" (read: experimental) procedure, having been performed exactly twice in the US this century.
2. The doctor even says "he can somewhat understand the insurance company’s initial reluctance at coverage".
3. The insurance company denied it because "unproven health services is not a covered benefit" - this is expected, the insurance company can't just take a single doctor's word that "it'll totally work, I'm super good at this surgery".
4. The insurance company ended up approving her claim.
Yah, that's a mistake (or lie) by the article; from your CNN article, she was initially put on the transplant list on Feb 2, and ended up approved by mid-May (it's after May 2, but before Mother's Day, on May 13).
She was delayed by "insurance issues" by at most 3 months.
She waited more than a year for a liver because she wasn't a good candidate for a liver transplant.
The issue I see with all this is the anger isn't because this CEO denied claims that should have been accepted (that would be reasonable anger), it's that they denied claims at all. How do people expect insurance to work? An insurance company that never denies claims doesn't stay in business.
(And obviously, yes, I think the US healthcare system is lousy. But in the system you have now, you have insurance companies, and they need to operate in the real world.)