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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

#111

Post by t344344 »

winrid wrote: post #79
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.

I have literally spent years trying to get an MRI for my knee after an accident. Both Kaiser and Anthem won't cover it.

I had MRI in EU, it was 160 euro for scan, and another 50 euro for specialist consultation. Public insurance would not cover it, so I paid it myself.

Not sure what is holding you back, but health should be a priority!

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

#112

Post by alphanullmeric »

harshalizee wrote: post #23
xwdv wrote: post #17

Earlier quoted context omitted.

Public health care can be similarly dystopian in other ways: Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy. No matter what society you live, the advice is the same: try not to get sick.

I moved from a third world country with both socialized and private healthcare, to the United States. I pay vastly more for worse healthcare than anywhere I've lived. The fact that you, your doctor can agree that a certain procedure is required, only to be denied by a third party with no medical qualification is absolutely dystopian.

Sounds like you should have stayed then.

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

#113

Post by kevviiinn »

gentoo wrote: post #91
firstlink wrote: post #39

Earlier quoted context omitted.

All claims being reviewed by big health insurance conglomerates is the antithesis of privatized healthcare. It incorporates the worst part of public healthcare and destroys the best potential benefit of privatized healthcare.

it's funny how whenever a big company does something bad that's actually an example of how socialism is bad

Mental gymnastics to avoid acknowledging that they've been brainwashed by capitalism

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

#114

Post by colinmorelli »

marginalia_nu wrote: post #74
hestefisk wrote: post #28

Earlier quoted context omitted.

You can have good public healthcare without the need of the notion of 'claims'. The Scandinavian healthcare system is a good example ( https://en.wikipedia.org/wiki/Healthcare_in_Denmark ).

Eh, my experience with health care in Sweden last couple of years is that almost no matter what your issue is, they'll ask what meds you are on, take your blood pressure, and some token blood samples and send you home. This costs $20. This process obviously does nothing to alleviate any medical issue, so you come back a few weeks later. You pay your $20. New doctor this time, who asks what meds you are on, takes your…

This anecdote may be true, but Sweden has significantly more favorable health outcomes across most dimensions compared to the US. Infant mortality, in-hospital mortality, etc.

In fact, most developed nations do. But part of what makes it so difficult to have a productive conversation about healthcare is that everyone has experience with the system in every single country, and bad experiences get passed around. So we say X country is doing better, and someone chimes in explaining how that country has its flaws.

They all have their flaws. But the US health system is measurably worse than most other developed nations across most axes that we care about. Though there are interesting questions about how much worse per-capita healthcare spend actually is given the comparatively higher R&D investment in the US.

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

#115

Post by pantulis »

specialist wrote: post #80
firstlink wrote: post #39

Earlier quoted context omitted.

All claims being reviewed by big health insurance conglomerates is the antithesis of privatized healthcare. It incorporates the worst part of public healthcare and destroys the best potential benefit of privatized healthcare.

What are some real world examples of beneficial privatized healthcare?

IMHO in privatized healthcare you are not the patient, you are the customer. As such, you should be having a better "customer journey" than in public healthcare: more immediate test/diagnostics, better experience in the hospital (like a room for yourself). And that's it. As a counterpart, it's not clear you are receiving the best medical attention. And of course you (through your employer) are paying for something that can be denied.

Note: I happen to have private healthcare with Cigna in a country with a reasonably good public health system (Spain, though it varies between different autonomous communities), happy to pay the taxes and will defend that public health systems are a staple of any modern country.

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

#116

Post by fnimick »

Timon3 wrote: post #89
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.

Don't you think it's a worthy goal to strive for this for all people in your country? Would you really try to block progress towards that goal due to your fear of being treated as they are right now, instead of putting your energy towards nobody being treated that way? Sincerely, if anyone can explain to me - how can we as a species both have figured out game theory, AND consider this as a position that is in any way…

Game theory explains it perfectly.

The current situation is that the parent poster has preferential healthcare access, and other people that they do not care about do not. The alternative is equal treatment which might mean the same access, or worse access as they are forced to "fight for attention alongside the general public" as they so blithely put it.

Given the option between the status quo, or a change which can only ever be the same or worse for you personally (regardless of the broader impact), of course someone self-centered would choose the former.

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

#117

Post by rgblambda »

So the law says a Doctor must review the claim. An algorithm does what effectively is a pre-review of each claim and the Doctor just clicks accept without even checking a single sample in each batch of pre-reviewed claims. This cannot possibly be legal.

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

#118

Post by kevviiinn »

fnimick wrote: post #104
yowzadave wrote: post #86

Earlier quoted context omitted.

> 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.

People love feeling like they're better than someone else, that's an ideal that's been floating around the US for quite some time. Ingroup outgroup stuff, great way for capital owners to keep the workers fighting amongst themselves and keep the attention where they want it

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

#119

Post by winrid »

t344344 wrote: post #111
winrid wrote: post #79

Earlier quoted context omitted.

I have literally spent years trying to get an MRI for my knee after an accident. Both Kaiser and Anthem won't cover it.

I had MRI in EU, it was 160 euro for scan, and another 50 euro for specialist consultation. Public insurance would not cover it, so I paid it myself. Not sure what is holding you back, but health should be a priority!

Yeah, that's an idea. It's like 10k here.

The trip to the EU, a vacation, and the MRI itself would be cheaper...

I was actually planning on getting it done on my next trip to China, which is about the same cost wise, and the doctors are good as they see so many people lol

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

#120

Post by drowsspa »

alphanullmeric wrote: post #112
harshalizee wrote: post #23

Earlier quoted context omitted.

I moved from a third world country with both socialized and private healthcare, to the United States. I pay vastly more for worse healthcare than anywhere I've lived. The fact that you, your doctor can agree that a certain procedure is required, only to be denied by a third party with no medical qualification is absolutely dystopian.

Sounds like you should have stayed then.

Is American healthcare a patriotic issue or something, that's why criticizing it warrants a "don't come here"? Where the hell does your comment come from?
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