http://calacanis.com/2007/12/21/cigna-kills-nataline-sarkisyan/ Just another WordPress site Wed, 10 Nov 2010 14:11:11 +0000 hourly 1 http://wordpress.org/?v=3.1.3 http://calacanis.com/2007/12/21/cigna-kills-nataline-sarkisyan/#comment-1071 Bee Sun, 26 Jul 2009 22:38:02 +0000 http://calacanis.wordpress.com/2007/12/21/cigna-kills-nataline-sarkisyan/#comment-1071 Why don't you tell the rest of the "self-funded insurance" story, Dawnybear? Plans may be "self-funded", but employers typically purchase stop-loss insurance to cover any claims over a certain amount. These self-funded plans also work typically just like a fully-funded plan, meaning that it is not the employee or the employer who call the shots as far as covered care, it is the insurance company who administrates the plan. So, for all intents and purposes, these "self-funded" plans still leave the insured at the mercy of a beancounter in a cubicle. The pooled insureds certainly have absolutely no control over the money, either. So, if the insureds don't have control over the money, then who does? The insurance company. And if what you say about the employer not funding hthe money were true, then the medical care of the employee is totally in the hands of the employer, which is ludicrous at best. Try thinking that one through next time when you decide to "educate" everyone on the difference between a self-funded and fully-funded insurance plan is. Why don’t you tell the rest of the “self-funded insurance” story, Dawnybear? Plans may be “self-funded”, but employers typically purchase stop-loss insurance to cover any claims over a certain amount. These self-funded plans also work typically just like a fully-funded plan, meaning that it is not the employee or the employer who call the shots as far as covered care, it is the insurance company who administrates the plan. So, for all intents and purposes, these “self-funded” plans still leave the insured at the mercy of a beancounter in a cubicle. The pooled insureds certainly have absolutely no control over the money, either. So, if the insureds don’t have control over the money, then who does? The insurance company. And if what you say about the employer not funding hthe money were true, then the medical care of the employee is totally in the hands of the employer, which is ludicrous at best. Try thinking that one through next time when you decide to “educate” everyone on the difference between a self-funded and fully-funded insurance plan is.

]]> http://calacanis.com/2007/12/21/cigna-kills-nataline-sarkisyan/#comment-1070 dawnybear Fri, 17 Apr 2009 04:08:46 +0000 http://calacanis.wordpress.com/2007/12/21/cigna-kills-nataline-sarkisyan/#comment-1070 It was very unfortunate that Natalie lost her battle to cancer. It is tragic when anyone goes through something like this. I know, I have lost my grandmother to cancer and supported my father through his battle with cancer as well. I don't believe that most people understand why this was not initially approved for Natalie. With ANY insurance company all treatment MUST be medically necessary and must also meet certain criteria to establish medical necessity. It is unfortunate. According to some reports, it was said that the procedure would have given Natalie another 6 months of life. Another point...most insurance plans are self-funded, meaning the employer (with the employee's premiums) pay for their claims. It is NOT the insurance company's money and most people do not understand that. Knowing this now, is it reasonable to ask the employer to fund this procedure for a patient that will only get another 6 months of life? Obviously, a transplant is quite expensive. If everyone who has comments such as this really understood the BIG picture, they wouldn't pin this on the insurance company....the insurance company ONLY administers the benefit for the EMPLOYER. The employer is quite aware of the insurance companies policies/procedures. Why aren't these folks asking why the EMPLOYER will not fund it. It is ultimatley the employer's money, not CIGNA's. It was very unfortunate that Natalie lost her battle to cancer.
It is tragic when anyone goes through something like this. I know,
I have lost my grandmother to cancer and supported my father
through his battle with cancer as well. I don’t believe that
most people understand why this was not initially approved for
Natalie. With ANY insurance company all treatment MUST be
medically necessary and must also meet certain criteria to
establish medical necessity. It is unfortunate. According to
some reports, it was said that the procedure would have given
Natalie another 6 months of life. Another point…most
insurance plans are self-funded, meaning the employer (with
the employee’s premiums) pay for their claims. It is NOT the
insurance company’s money and most people do not understand
that. Knowing this now, is it reasonable to ask the employer
to fund this procedure for a patient that will only get
another 6 months of life? Obviously, a transplant is quite
expensive. If everyone who has comments such as this really
understood the BIG picture, they wouldn’t pin this on the
insurance company….the insurance company ONLY administers
the benefit for the EMPLOYER. The employer is quite aware of
the insurance companies policies/procedures. Why aren’t
these folks asking why the EMPLOYER will not fund it. It is
ultimatley the employer’s money, not CIGNA’s.

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