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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

#121

Post by theGnuMe »

binarymax wrote: post #105

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.

Yeah that's basically a true story, also before the ACA there were plans that would deny your insurance claiming that you lied during the underwriting process if you used the insurance. It was big news at the time and lots of state action against those plans.

I think Cigna needs to be sued class action style for denials. I think it would probably work in the case where Cigna is operating as the claims administrator which is where your company self-insures (so they pay the claims) but Cigna just deals with the paperwork. I would not be surprised if Cigna advertises its services to large companies as "cost effective" etc...

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

#122

Post by avgDev »

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!

Because in US MRI is $1000 to $8000.

It is a joke.

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

#123

Post by rqtwteye »

ryanSrich wrote: post #107
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.

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.

I am from Germany and agree that US healthcare is very shiny. But once you get sick it’s very easy to get stuck in an extremely expensive bureaucratic nightmare between hospitals and insurances. I prefer the German system where I can go to a doctor or ride an ambulance without the fear of having to pay tons of money.

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

#124

Post by theGnuMe »

ncallaway wrote: post #31

I genuinely think every health insurance denial should have to come from a named doctor at the health insurance company who is personally and professionally liable for the health outcomes from a denial. Deny someone life-saving care without a sound medical reason? That’s a malpractice lawsuit and a potential loss of their medical license.

There's some doc on twitter who was denied by insurance and he filed a board complaint against the insurance doc claiming malpractice. I think he won.

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

#125

Post by illiarian »

xwdv wrote: post #52
nathan_compton wrote: post #48

Earlier quoted context omitted.

This might be true, but as someone who has lived in the U.S. and Europe I can say utterly unequivocally that I preferred Health Care in Europe. I wasn't even in one of the European countries with a great reputation for Health Care. Health Care in the U.S. isn't just bad, its outright fucking brutal. An elderly friend of mine recently fell and went to an urgent care where they couldn't get him into the x-ray machine.…

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.

> If I was in a public system, I’d fear I’d be fighting for attention alongside the general public

Ah yes, how dare the plebs interfere with the path of the chosen ones.

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

#127

Post by nrb »

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!

An MRI in the US without insurance coverage can reach up to several thousand dollars.

Heck, WITH insurance you can expect it to cost up to around $1000 depending on coverage.

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

#128

Post by avgDev »

xwdv wrote: post #52
nathan_compton wrote: post #48

Earlier quoted context omitted.

This might be true, but as someone who has lived in the U.S. and Europe I can say utterly unequivocally that I preferred Health Care in Europe. I wasn't even in one of the European countries with a great reputation for Health Care. Health Care in the U.S. isn't just bad, its outright fucking brutal. An elderly friend of mine recently fell and went to an urgent care where they couldn't get him into the x-ray machine.…

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 have been to an ER in a top US hospital. Waited 6 hours.

This anecdotal evidence is garbage.

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

#129

Post by hirsin »

winrid wrote: post #119
t344344 wrote: post #111

Earlier quoted context omitted.

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

I get a screening in India when I visit some family there. Full blood work, you call in the morning, they come by the house and draw it, results in the next morning. It's faster and cheaper to do that, including the flights, than to try and get this done through my doctor in the US.

So, yeah, go for it.

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

#130

Post by eric-hu »

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!

Do you know if an American could go to where you are and pay for an MRI and doctors visit out of pocket?
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