A Nashville teacher found the promise of a lifesaving lung transplant withdrawn by her insurer at the last second right before Thanksgiving, and then ultimately approved after pressure was brought by social media.
“A thread about our depraved healthcare system, and a plea. In 2021, my friend Carole was diagnosed with terminal stage four cancer. A single parent with two kids, she had just turned 43. In 2017, she had watched her brother Chris die of the same cancer. He too was in his 40s,” Brian Goldstone, a journalist, posted over on X Twitter.
Doctors diagnosed her, and worked her up, with little encouragement, he wrote, on Nov. 21. “The five-year survival rate for [this] lung cancer is 5%. She began chemo,” he wrote.
“Then, earlier this year, a ray of hope: doctors at @VUMChealth told her she might be a candidate for a double lung transplant, which would remove the cancer. But first they had to ensure that it was confined to her lungs. Six months of rigorous screening and evaluation ensued.”
The Vanderbilt University team decided she was a good candidate. Her insurer, Cigna, agreed to pay. She was called and told there was a match for a donated set of lungs, and she should come in on Nov. 20.
Cigna refuses to pay
“At 3:45, as the transplant team was prepping the OR, a doctor came to Carole’s room. She had terrible news. @Cigna, Carole’s insurance company, had just denied her claim. They’d made a mistake, they said, in initially approving the procedure. They were now refusing to pay for it.”
“Carole and her kids were sent home, and she was taken off the waitlist for a donor match. Her doctors have promised to appeal @Cigna‘s decision next week. In the meantime, there is concern about the cancer spreading. If that happens, a transplant will no longer be an option.”
“Now for the plea. Carole’s doctors at Vanderbilt are convinced that this transplant can save her life. But @Cigna will need to reverse their decision—and quickly. The company’s CEO is David Cordani. He can be reached at David.cordani@cigna.com.”
Hundreds of people posted on X Twitter that they would write appeals.
Goldstone then added an update: Within an hour of posting, he said, “a representative from @Cigna called Carole to say they were aware of her situation and would be “escalating” her case. So the public pressure seems to be having an effect. Let’s keep it up.”
Finally, On Nov. 22, Cigna reversed itself:
“UPDATE: After a tremendous outcry, Cigna has reversed their unconscionable last-minute denial and will be covering Carole’s transplant (!!). Carole is extremely relieved, and she’s grateful to the many, many people who emailed Cigna over the past 24 hours. Having said that…”
“Carole is acutely aware that, without public pressure, Cigna might well have cut short her life—just as so many others have been harmed by this cruel, profit-driven system. It’s shameful that an insurance company has the power to prevent anyone from receiving the care they need.”
But she is still in limbo.
Goldstone Tweeted “The donor lungs Carole was supposed to receive on Monday are no longer available; because of @Cigna, the transplant was canceled. Carole will now need to undergo additional tests to ensure the cancer has not spread. She will then (hopefully) be placed back on the waitlist.”
Before the reversal, Taylor wrote on Substack: “Our healthcare system is not simply broken, it is corrupt and anti-life. When a company has the power to step in moments before a life-saving surgery and refuse coverage despite the medical experts insisting it is crucial, time-sensitive, and all other options have been carefully weighed, there is no logical explanation other than greed.”
In a statement to USA Today about the case, Cigna wrote: “There are a number of unique circumstances in this case, and we have moved swiftly to resolve our error so (Carole Taylor’s) transplant will be covered. We deeply regret the pain and stress this has caused (Taylor) and her loved ones.””
Cigna has come under fire for denying appeals for health care claims without ever opening a patient’s file to assess it. ProPublica and Capitol Forum revealed the practice in an investigation earlier this year, documenting how the review process for denied claims is described as “click and submit.”
