It’s what insurance companies do. Richard Blair explains the dangers of allowing persons with a fiducuiary interest in (that means who will make money from) denying care to be making decisions about care:
Ms. Sarkysian had leukemia, and was admitted to a California hospital for a bone marrow transplant. As is possible with such procedures, there were complications, and her kidneys and liver failed. Her brother donated a kidney. She was ready for a liver transplant (a relatively routine procedure in this day and age), but even though hers had failed, her family’s insurance company would not approve the procedure by claiming it was “experimental”. In other words, a bean counter at Cigna made the decision that since they had already shelled out a lot of cash for the bone marrow and kidney transplant, that the cost of a liver transplant and followup care was just too high.
To Cigna, the cost of Nataline’s transplant was like buying a Nintendo Wii. When you buy a Wii, it’s not so much the initial investment in the game machine, but the ongoing followup costs in purchasing games and other hardware add-ons. The risk managers at Cigna who made the decisions in Nataline’s case weren’t so much looking at the cost of the initial transplantation procedure, but the annual cost of followup care and medication.
Nataline was 17 years old. The average lifespan of a woman in America is 79.1 years.
The (possible projected–ed.) cost of her followup care for the next (projected) 62 years: $1,302,000.