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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

#131

Post by hayst4ck »

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.

Do you think your health care experience represents the median healthcare experience in all 5 countries?

If we divide up people into percentiles based on wealth, 25, 50, 75, 95, how do you think people fare in the different countries? How do you think they the median experience is in America?

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

#132

Post by switch007 »

> “Put yourself in the shoes of the insurer,” Howrigon said. “Why not just deny them all and see which ones come back on appeal? From a cost perspective, it makes sense.”

This is more or less how the UK government handles benefits (welfare) applications.

It’s cruel and demeaning and damaging to health in many many cases.

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

#133

Post by rsyring »

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.

My family has received multiple radiology procedures including x-ray, MRI, and ultrasound from private radiology businesses (I.e. not the hospital). They are typically 10x give or take less expensive. Last MRI was $600.

Doesn't help if you are stuck in the hospital. But, it's an option otherwise.

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

#134

Post by interstice »

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.

An ironic use of the phrase survivorship bias springs to mind

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

#136

Post by alphanullmeric »

drowsspa wrote: post #120
alphanullmeric wrote: post #112

Earlier quoted context omitted.

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?

Nothing to do with patriotism, I just question why supporters of collectivism constantly flee to capitalist countries.

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

#137

Post by johngladtj »

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

A key component of the free market is the ability to say "no thanks" to an offer to do business.

Can you explain to me how the government telling you "you must do business with one of these insurers or else" is in any way a free market?

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

#138

Post by EnglishRobin96 »

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.

Having lived the opposite, I have to strongly disagree. I lived the nightmare of US healthcare, where my provider decided to stop working in my state, which meant that I no longer had access to any doctors under health insurance despite it being paid for by my company.

The UK was amazing - no questions asked care for my health was a massive improvement over what I had in the US. Free access to a doctor at any time is more life changing that you can think - every health issue I had I could talk to a medical professional and get guidance. Even free mental health care.

Moved to Ireland last year, with a mixed public/private system, and my health is now slipping a bit. Going to a GP, trying to file for reimbursements, and knowing that every time I have a health concern, it will cost me money, is a powerful suppressing force. I miss the NHS.

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

#139

Post by stouset »

Centigonal wrote: post #108
stouset wrote: post #69

Earlier quoted context omitted.

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-p…

I’m not defending the current system at all.

I was simply trying to say that, within the confines of the current system, this particular actor has not gone out of their way to fuck me over in the same way that I hear about so many other actors.

I have no idea if my experience with Aetna is common or an outlier. My hope was that by posting this, it would provide a data point for people forced to choose a private health insurance provider in the future. I also hoped to hear from others who had experiences either mirroring or opposite my own.

If I could, I would dismantle our current system in a heartbeat and replace it with some form of single-payer. I can’t, so I tried to provide information about one player within the incredibly fucked up system Americans are forced to operate within.

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

#140

Post by yborg »

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!

That MRI would probably bill out at >US$ 1000 in most urban areas in the US. I've been billed $300 for a simple shoulder X-ray.

The real kicker is that you generally can't even find out this price until you have the procedure and receive the bill. It's become almost akin to a legal mafia cartel. In my area, a majority of the urologists have become part of a medical group that now dictates pricing for related procedures. Most of the major insurance carriers don't want to pay this pricing so this group is not a covered provider, so finding a urologist that is covered entails sometimes waits of months for an appointment.

It's the worst parts of socialized and for-profit health care assembled into one system.

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