Did you know you can bring a lawsuit against your HMO if one its employees gives you “the finger,” but not if it wrongly denies your child a life saving transplant?
Such is the moral of a terrible story involving a woman named Hilda Sarkisyan whose17-year-old daughter died after the family’s health insurer (Cigna) refused to pay for a desperately-needed liver transplant, calling it “experimental.”
Strange as that may sound, under the federal ERISA law, if you are insured through your employer, your HMO can’t be held liable for injuries or death when it denies treatment. The Sarkisyan family learned about this outrageous loophole when a Los Angeles judge citing “a 1987 U.S. Supreme Court ruling that shields employer-paid healthcare plans from damages over their coverage decisions” tossed their wrongful death suit against Cigna.
As Wendall Potter, a former Cigna spokesman who resigned in the wake of the Sarkisyan case, observed, “"HMOs and insurers are largely free to deny access to care without fear of reprisal or financial consequences."
Meanwhile, desperate for some semblance of justice, Sarkisyan and a group of supporters paid a visit to the Cigna’s Philadelphia headquarters (see video below) demanding an apology from the company’s CEO. That’s where the “middle finger” comes in.
A group of Cigna employees looking down at Sarkisyan from a nearby balcony began “heckling” her—and one apparently thought it would be a terrific idea to “flip off” the grieving mother.
“They showed me their true colors,” said Sarkisyan. “Shame on them.”
In a testament to how bizarre the ERISA/HMO immunity provision really is, the “bird flipping” moment has now become “the central element of a lawsuit Sarkisyan and her husband Grigor, are pressing against the health insurer.” A U.S. District judge gave the family the green light to pursue this claim.
“They kill a beautiful 17-year-old girl, and I get to go after them for a finger? That’s sick,” said Hilda Sarkisyan,” adding, “If you don’t sue, you can’t make changes…It’s not about the money. It’s about the principle. They are just going to keep denying people care if we don’t stop them.”
Check out what Consumer Watchdog is trying to do to fix this situation.
As the late Senator Ted Kennedy (D-Mass.), who led an unsuccessful attempt to close the ERISA/HMO loophole back in 2001 said at the time, “"Patients should have the right to hold their HMO accountable in court when its negligence causes the injury or death of a patient….No other industry in America enjoys immunity from accountability for its actions, and the insurance industry does not deserve it either."
So next time you hear people complaining about lawsuits for medical malpractice, make sure to remind them that HMOs are completely immune from liability.
Such is the moral of a terrible story involving a woman named Hilda Sarkisyan whose17-year-old daughter died after the family’s health insurer (Cigna) refused to pay for a desperately-needed liver transplant, calling it “experimental.”
Strange as that may sound, under the federal ERISA law, if you are insured through your employer, your HMO can’t be held liable for injuries or death when it denies treatment. The Sarkisyan family learned about this outrageous loophole when a Los Angeles judge citing “a 1987 U.S. Supreme Court ruling that shields employer-paid healthcare plans from damages over their coverage decisions” tossed their wrongful death suit against Cigna.
As Wendall Potter, a former Cigna spokesman who resigned in the wake of the Sarkisyan case, observed, “"HMOs and insurers are largely free to deny access to care without fear of reprisal or financial consequences."
Meanwhile, desperate for some semblance of justice, Sarkisyan and a group of supporters paid a visit to the Cigna’s Philadelphia headquarters (see video below) demanding an apology from the company’s CEO. That’s where the “middle finger” comes in.
A group of Cigna employees looking down at Sarkisyan from a nearby balcony began “heckling” her—and one apparently thought it would be a terrific idea to “flip off” the grieving mother.
“They showed me their true colors,” said Sarkisyan. “Shame on them.”
In a testament to how bizarre the ERISA/HMO immunity provision really is, the “bird flipping” moment has now become “the central element of a lawsuit Sarkisyan and her husband Grigor, are pressing against the health insurer.” A U.S. District judge gave the family the green light to pursue this claim.
“They kill a beautiful 17-year-old girl, and I get to go after them for a finger? That’s sick,” said Hilda Sarkisyan,” adding, “If you don’t sue, you can’t make changes…It’s not about the money. It’s about the principle. They are just going to keep denying people care if we don’t stop them.”
Check out what Consumer Watchdog is trying to do to fix this situation.
As the late Senator Ted Kennedy (D-Mass.), who led an unsuccessful attempt to close the ERISA/HMO loophole back in 2001 said at the time, “"Patients should have the right to hold their HMO accountable in court when its negligence causes the injury or death of a patient….No other industry in America enjoys immunity from accountability for its actions, and the insurance industry does not deserve it either."
So next time you hear people complaining about lawsuits for medical malpractice, make sure to remind them that HMOs are completely immune from liability.
It's every bit that bad and more. ERISA needs to be amended if any real "reform" is to be achieved. Further background is available at my ERISA-reform blog:
http://problemiserisa.blogspot.com
Posted by: Richard Johnston | October 09, 2009 at 06:43 PM