Cigna saves millions by having its doctors reject claims without reading them
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Re: Cigna saves millions by having its doctors reject claims without reading them
#2This reminds me of the US patent approval system. There are too many claims to properly vet them all, so just "click and submit" and only put effort into the ones that come back to complain. (Except the PTO is biased toward approval and not rejection, of course.)
Re: Cigna saves millions by having its doctors reject claims without reading them
#3This has been happening to me for the past several months.
1. Cigna will not tell you for any reason, why the claim is denied
2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial
3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT code for therapy is the same as the equipment code for injections.
So one claim processor decided that the claim was for injections and denied it. Then every subsequent claim has been denied under the same reason.
4. At this point the only option for me is for my provider to appeal every single claim (which takes months), as this is the only way to get someone to actually read the claim and make an intelligent decision.
An absolute nightmare :(
Re: Cigna saves millions by having its doctors reject claims without reading them
#4This has been happening to me for the past several months. 1. Cigna will not tell you for any reason, why the claim is denied 2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial 3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT…
I always wonder if small claims court could be somewhat viable. In the instances where I’ve fought and gotten approval, I’ve spent my own time, my own money, and had my health deteriorate. Ideally, I’d like to be compensated for the time I’ve spent defending myself to this company, and I’d like some form of remuneration (somewhat for retribution, somewhat as a negative incentive to the company) for my now diminished health…
Re: Cigna saves millions by having its doctors reject claims without reading them
#5 “We thought it might fall into a legal gray zone,” said the former Cigna official, who helped conceive the program. “We sent the idea to legal, and they sent it back saying it was OK.”
Re: Cigna saves millions by having its doctors reject claims without reading them
#6This has been happening to me for the past several months. 1. Cigna will not tell you for any reason, why the claim is denied 2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial 3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT…
I always wonder if small claims court could be somewhat viable. In the instances where I’ve fought and gotten approval, I’ve spent my own time, my own money, and had my health deteriorate. Ideally, I’d like to be compensated for the time I’ve spent defending myself to this company, and I’d like some form of remuneration (somewhat for retribution, somewhat as a negative incentive to the company) for my now diminished…
There needs to be something like the CFPB for health care. I couldn't get an actual human to acknowledge me when dealing with PNC when they ate up my bank, but one CFPB complaint got them to do exactly what I asked. That way you never get to the point of burning time, money, and health because they're afraid of action from the agency.
Re: Cigna saves millions by having its doctors reject claims without reading them
#7Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Any system that requires balancing human suffering against profitability is inevitably going to optimize for profitability.
The fact that this is even a thing is mind boggling.
Re: Cigna saves millions by having its doctors reject claims without reading them
#8And still Cigna’s profit margins are low single digit percentages.
https://www.macrotrends.net/stocks/charts/CI/cigna-group/pro...
Wonder what premiums and out of pocket maximums would have to be if there were fewer denials.
Re: Cigna saves millions by having its doctors reject claims without reading them
#9Earlier quoted context omitted.
I always wonder if small claims court could be somewhat viable. In the instances where I’ve fought and gotten approval, I’ve spent my own time, my own money, and had my health deteriorate. Ideally, I’d like to be compensated for the time I’ve spent defending myself to this company, and I’d like some form of remuneration (somewhat for retribution, somewhat as a negative incentive to the company) for my now diminished…
There needs to be something like the CFPB for health care. I couldn't get an actual human to acknowledge me when dealing with PNC when they ate up my bank, but one CFPB complaint got them to do exactly what I asked. That way you never get to the point of burning time, money, and health because they're afraid of action from the agency.
It would be the state’s insurance regulator, although do not know if they are as effective as CFPB. Financial issues tend to be much less complicated than health issues, and usually just a result of understaffing and underinvesting in customer service.
Re: Cigna saves millions by having its doctors reject claims without reading them
#10I wish I was surprised. Automated decision-making with little to no human oversight is the dream of risky bets (policing, insurance, loans, etc).