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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

#151

Post by AlexandrB »

johngladtj wrote: post #137
gentoo wrote: post #91

Earlier quoted context omitted.

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?

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

So a free market in health care is not possible because you can't consider your options and say "no thanks" when you need emergency treatment. Whatever the government does or does not do, you can't really get around the fact that at a moment of crisis health care providers have you in a coercive situation and could charge life changing amounts for care if they were permitted to.

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

#152

Post by dboreham »

casenmgreen wrote: post #146
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 may be completely wrong, but I understand in the US normally people have health care through their employer? so they are not themselves paying the insurer, and cannot change insurer. If this is the case, then it is no wonder the insurer has no particular care for them. It is the power of the consumer to change provider which gives them influence over the provider.

Even if not employer provided, there's usually little choice in carriers due to anticompetitive practices and regulatory capture.

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

#153

Post by xwdv »

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.

Post COVID hospital in Ohio, limped in with severe ankle sprain, got doctor in less than 15 minutes and out within an hour with splint and crutches. Even got X-Ray.

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

#154

Post by A4ET8a8uTh0 »

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.

Eh. I did in Poland, but, admittedly, it is a poster child of how to do it so badly that people opt for now existing separate private care. It is, however, definitely a negative example of socialized health care.

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

#155

Post by dboreham »

emodendroket wrote: post #76
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.

How is that so? The health insurance conglomerates are in private hands.

Parent probably means that those companies are part of a government sponsored cleptocracy.

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

#156

Post by javajosh »

camhart wrote: post #73

Why can't healthcare be fixed? I'm self employed, pay a crap ton of money for "good" insurance, and it's horrible. It's very difficult to find good doctors in network. Everything gets rejected from insurance and the Dr has to appeal it multiple times in order to sometimes get them to budge. It's absolutely broken, and even more so for those on individual and family plans (ie not through an employer). Last year I was…

>Why can't healthcare be fixed?

Because doctors and patients won't fix it. Doctors can charge whatever they want. They could see more patients, charge less, and charge cash. They could do their own diagnostics during the visit. People from other countries will be shocked to know that US doctors never do their own diagnostics, and instead refer patients to other providers, which require their own payment and paperwork, another round of appointments.

Putting the patient through all that for an ultrasound is "standard practice", which also happens to be maximally profitable for multiple providers and their associated office staffs, and the enormous industries that exist to service this deeply problematic "standard practice".

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

#157

Post by WarOnPrivacy »

zamadatix wrote: post #78
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.

Only ~8% of people are uninsured so I wouldn't be so quick to distance yourself from being "the general public". Besides, you don't need insurance to be stabilized in an ER that only comes into play after (or if you enter with a non-emergency). 30 minutes is pretty good though, especially if it's the latter type of visit, it'd be about 3x better than the best state average https://www.beckershospitalreview.com/rankin…

Regarding the CPS ASEC ~8% number, census.gov seems to track insured Americans similar to how the FCC tracks broadband availability[1].

This ~92% insured in 2020 includes:

- People subscribed to unusable ACA and private plans (eg: $9100 deductibles)

- People considered eligible for Medicaid by CMCS, including those who are denied coverage by state administration agencies

- Millions of people who were directly granted temporary Covid Medicaid coverage by CMCS (bypassing state agencies) - which expires in days

[1] FCC broadband maps consider an entire census tract served, as long as an ISP alleges just one house there can be served.

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

#158

Post by kofejnik »

camhart wrote: post #73

Why can't healthcare be fixed? I'm self employed, pay a crap ton of money for "good" insurance, and it's horrible. It's very difficult to find good doctors in network. Everything gets rejected from insurance and the Dr has to appeal it multiple times in order to sometimes get them to budge. It's absolutely broken, and even more so for those on individual and family plans (ie not through an employer). Last year I was…

It is working as intended. All parts of the system co-evolved to extract maximum value from you.

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

#159

Post by eapressoandcats »

camhart wrote: post #73

Why can't healthcare be fixed? I'm self employed, pay a crap ton of money for "good" insurance, and it's horrible. It's very difficult to find good doctors in network. Everything gets rejected from insurance and the Dr has to appeal it multiple times in order to sometimes get them to budge. It's absolutely broken, and even more so for those on individual and family plans (ie not through an employer). Last year I was…

In the US at least the underlying problem is that we pay more for basically every medical procedure, drug, and device, so you end up paying more to get less. Largely this is due to having engineered a shortage of doctors combined with no negotiation on drug and medical device prices.

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

#160

Post by alpaca128 »

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 paid $3,300, which was the remainder of my total annual out-of-pocket

So with insurance you paid more than a European without insurance would, and you call that a counterpoint?

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