The insurer tarried as second ticked away for the liver transplant plant of the Californian teenager Nataline Sarkisyan.
By the time the Cigna HealthCare made up its mind, it was too late. Her devastated parents hold the insurers squarely responsible for her death and are planning to sue them.
AdvertisementTheir lawyer, Mark Geragos, will ask the Los Angeles district attorney to press murder or manslaughter charges against Cigna HealthCare, arguing that the firm "maliciously killed" Nataline Sarkisyan.
The 17-year-old from Glendale, California, had been in a coma for weeks after complications following a bone marrow transplant to counter leukaemia.
After the operation, her liver failed and doctors referred her for an emergency transplant. Although she was fully insured and had a matching donor, Cigna refused to pay on the grounds that her healthcare plan "does not cover experimental, investigational and unproven services".
Cigna's rejection on December 11 led Sarkisyan's doctors at UCLA medical centre, including the head of its transplant unit, to write a letter to protest that the treatment which they proposed was neither experimental nor unproven. They called on the firm to urgently review its decision.
In the absence of a response from Cigna, doctors told the Sarkisyan family that the only alternative would be for the family to pay. But they could not afford the immediate down payment of $75,000 (Ģ38,000).
The family, backed by nurses, relatives and Sarkisyan's friends, mounted a protest of 150 people outside Cigna's Glendale offices. "Cigna cannot decide who is going to live and who is going to die," the teenager's mother, Hilda Sarkisyan, told the crowd.
The demo was amplified by an internet campaign orchestrated by the liberal Daily Kos website and other blogs that bombarded Cigna's HQ in Philadephia. In the middle of the rally, a note was handed to Mrs Sarkisyan saying that Cigna had decided to reverse its decision.
"Cigna HealthCare has decided to make an exception in this rare and unusual case and we will provide coverage should she proceed with the requested liver transplant," it said in a statement.
The news drew cheers from the crowd, but they quickly grew sombre when they heard Sarkisyan's condition had deteriorated. A few hours later, her life support was switched off.
"She passed away, and the insurance [company] is responsible for this," Mrs Sarkisyan told the Los Angeles Daily News.
"Why did it take public humiliation for a multibillion-dollar insurance company to force them to provide appropriate medical care?" asked Charles Idelson of the California Nurses Association.
"This is what's wrong with our health system - insurers decide treatment, not doctors."
The protests over Sarkisyan's case point to growing public disenchantment with the healthcare system in America.
Politicians vying to be the Democratic candidate for the presidential race next year have prepared plans for reform to bring the 47 million uninsured Americans into the healthcare net, and to improve terms for those already insured like Sarkisyan.
The subject was given an added boost this summer by Michael Moore's documentary on the state of the American health service, Sicko.
Moore refers to the case of Sarkisyan on his website, under the simple banner: "Justice delayed is justice denied."
Following the teenager's death, Cigna issued another statement yesterday.
"Their loss is immeasurable, and our thoughts and prayers are with them," it said. "We deeply hope that the outpouring of concern, care and love that are being expressed for Nataline's family help them at this time."
The company recently posted figures for its third-quarter performance this year, which showed profits up 22%. Next year it expects to earn an income of up to $1.2bn.