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Cigna saves millions by having its doctors reject claims without reading them

propublica.org

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Re: Cigna saves millions by having its doctors reject claims without reading them

#101

Post by rr808 »

dafelst wrote: post #7

Privatized 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.

> Privatized health care as a person's sole option for care is an absolute dystopian nightmare.

Dont exaggerate. I've lived in 3 European countries and Australia. My American healthcare is easily better than those. Sure I'm lucky to have a good job that pays for it, but you can't say its terrible without looking at how those public systems are really struggling right now.

Re: Cigna saves millions by having its doctors reject claims without reading them

#102

Post by glenstein »

KyleJune wrote: post #88
xwdv wrote: post #52

Earlier quoted context omitted.

I’m fully insured and have always been well taken care of in the United States health care system. Never wait more than 30 minutes if I were in an emergency room, and usually I’m attended to within 10-15. Doctors appointments are easy to get, never paid much for prescriptions. If I was in a public system, I’d fear I’d be fighting for attention alongside the general public, so I’m not convinced it would be better.

Where is the wait only 30 minutes? Every time I've been to the emergency room the wait has been 6+ hours. I think the only way it would be that fast at the hospitals I've been to is if you'd die waiting longer, otherwise it's a long wait.

I am also fully insured and I have never once heard of emergency rooms with an average wait time of 30 minutes in the United States.

Re: Cigna saves millions by having its doctors reject claims without reading them

#103

Post by walls »

rr808 wrote: post #101
dafelst wrote: post #7

Privatized 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.

> Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Dont exaggerate. I've lived in 3 European countries and Australia. My American healthcare is easily better than those. Sure I'm lucky to have a good job that pays for it, but you can't say its terrible without looking at how those public systems are really struggling right now.

Oh, well as long as you personally have not yet had a problem.

Everything is fine everyone, no need to worry.

Re: Cigna saves millions by having its doctors reject claims without reading them

#104

Post by fnimick »

yowzadave wrote: post #86
xwdv wrote: post #52

Earlier quoted context omitted.

I’m fully insured and have always been well taken care of in the United States health care system. Never wait more than 30 minutes if I were in an emergency room, and usually I’m attended to within 10-15. Doctors appointments are easy to get, never paid much for prescriptions. If I was in a public system, I’d fear I’d be fighting for attention alongside the general public, so I’m not convinced it would be better.

> I’d fear I’d be fighting for attention alongside the general public Are you not a part of the "general public"? If it is true that there is a class of people who don't have your advantages and therefore have worse medical care, is that a situation that you see as acceptable? It always seems strange to me when people argue this about this issue from a hypothetical perspective, when we have a wealth of actual data th…

> If it is true that there is a class of people who don't have your advantages and therefore have worse medical care, is that a situation that you see as acceptable?

The answer is obviously yes, given that they don't want the "general public" to have the same level of access and make them potentially have to endure any longer waits. Their convenience is more important than the health of others.

Re: Cigna saves millions by having its doctors reject claims without reading them

#105

Post by binarymax »

The fictional story “The Rainmaker” is about a fictional insurance company with a secret internal policy to deny all claims on first submission, and only fulfill some claims on appeal.

It was meant to be fiction, but I suppose it’s not. This whole company should go down for fraud.

Re: Cigna saves millions by having its doctors reject claims without reading them

#106

Post by jfengel »

rr808 wrote: post #101
dafelst wrote: post #7

Privatized 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.

> Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Dont exaggerate. I've lived in 3 European countries and Australia. My American healthcare is easily better than those. Sure I'm lucky to have a good job that pays for it, but you can't say its terrible without looking at how those public systems are really struggling right now.

The article suggests that your health care isn't as good as you think it is. You never know if you'll be one of those cases where they make you fight for every bit of care you get.

Some Americans do get excellent care with a minimum of grief. Others think their insurance is fine while they're healthy and only discover later that it doesn't really cover what they imagine it does. And the difference is entirely arbitrary.

The fundamental problem of health insurance is that you cannot know what you will need, and there is no way to make an informed consumer choice, but your need when you have it is absolute. It's pathologically pessimal as a free market. And you usually don't know until it's too late.

Re: Cigna saves millions by having its doctors reject claims without reading them

#107

Post by ryanSrich »

rr808 wrote: post #101
dafelst wrote: post #7

Privatized 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.

> Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Dont exaggerate. I've lived in 3 European countries and Australia. My American healthcare is easily better than those. Sure I'm lucky to have a good job that pays for it, but you can't say its terrible without looking at how those public systems are really struggling right now.

Yeah this is a very common sentiment. I feel like most people in the US haven’t actually talked to someone that has experience with socialized healthcare at scale. I had a German professor that was very clear about just how much better healthcare is in the US.

Re: Cigna saves millions by having its doctors reject claims without reading them

#108

Post by Centigonal »

stouset wrote: post #69
blakesterz wrote: post #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.” Reading this article is just maddening. I've been dealing with different insurers for the past 7 years or so, and it's my experience they must all do something similar. Anyone with any kind of serious health condition is regularly driv…

Counterpoint. I have an Aetna PPO and experienced a stroke last year. $100,000+ hospital stay and insurance just… covered it. I paid $1,100 out of pocket. I had a $100,000+ surgery a few weeks ago to repair a heart issue that may have led to it. They just covered it. No fuss, no hassle. I paid $3,300, which was the remainder of my total annual out-of-pocket, and now I will pay $0 for healthcare for the rest of the ye…

I'm glad you had such a good experience. Not a counterpoint, though.

Healthcare is like running water, bridges, or banking systems - a high-volume system with extremely high stakes. We need many nines of consistency as protection against preventable harm.

There are around ~35M hospital admissions in the US every year. Even if 9/10 patient experiences are like yours, that means more than 3.5 million people had a sub-par experience that year - that's the entire population of LA. We need to strive for a much higher bar of quality and consistency.

Re: Cigna saves millions by having its doctors reject claims without reading them

#109

Post by [deleted] »

walls wrote: post #103
rr808 wrote: post #101

Earlier quoted context omitted.

> Privatized health care as a person's sole option for care is an absolute dystopian nightmare. Dont exaggerate. I've lived in 3 European countries and Australia. My American healthcare is easily better than those. Sure I'm lucky to have a good job that pays for it, but you can't say its terrible without looking at how those public systems are really struggling right now.

Oh, well as long as you personally have not yet had a problem. Everything is fine everyone, no need to worry.

[deleted]

Re: Cigna saves millions by having its doctors reject claims without reading them

#110

Post by Jcowell »

kurthr wrote: post #61
anigbrowl wrote: post #27

Earlier quoted context omitted.

Standard answer is we can't tell you why you were rejected How did you find out about the automatic rejection/identity of the reviewers?

That is a good question. The first appeal was "free" so we didn't have to justify it with anything other than, "no really the surgery is necessary". They only gave us a rejection number on the second and third rejections and we had to request the written forms by mail, which took weeks. The written form didn't have much more, mostly boiler plate, but it did have the number (and maybe a chapter/paragraph number citati…

How on earth can some one read this and think that the American Health System isn’t fucked up?

Can someone explain to me why the model we choose to pay for the health for the populous of this country is through insurance and not straight up taxes??

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