Family sues insurer who denied teen transplant - Health care- msnbc.com

Family sues insurer who denied teen transplant - Health care- msnbc.com

As I started reading this, a very cynical thought occurs to me. How very stupid they are to have reversed it in the last minutes. If they had simply stuck to their original decision and said "We are sorry, but that is the way it is" they would probably get away with this if they originally had as leg to stand on in the denial.

If they did not, nothing would help them, but in reversing their decision, they open the door for accusations that they made a mistake in denying it in the first place, making them liable for the death.

Now... I think this before actually having finished the article to know whether or not they had grounds in the denial in the first place. That in itself brings up so many issues; primarily, what right does the insurance company have to make medical decisions in the first place.

If the patients doctor says it is a viable option, what right does the insurance company have to deny the treatment? No one with half of a brain-cell can argue that they do it for any reason OTHER than money. "It has a low chance of success" is nothing more than saying that "There is a good chance that the money would be wasted".

The argument that someone else could use that organ is an emotional appeal, but not a legitimate argument, because the doctors on the transplant teams are the specialists. They know the risks, they know the chances, they know the patient. And they know that there are more people than available organs.

Additionally, just because there are other people on the list who are a match for that organ, that does not mean they are necessarily in competition for that organ. Sending a fresh organ across the country to someone else, means that the organs chances of being accepted are dropping... usually to the point where a patient with a 'better' chance of survival with a FRESH organ looses that edge with an organ not so 'fresh'.

I think it comes down to something very simple. If the insurance company can show that THEY had another patient with an over all better chance of survival and made the choice based on that, then they are off the hook... if they are going to pay for it, they are justified in choosing the person with the best chances of survival based on the doctors judgement. If that is the case and they denied it simply based on HER chances, then they should be treated the same way a bank robber would be charged if a teller were killed during the commission of their crime.