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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

#161

Post by earthling8118 »

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…

To me this is similar to being "stuck in traffic" as if it is something that you are experiencing. No, you ARE the traffic. The congestion didn't come to ruin your day. You contributed to it too.

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

#162

Post by karmelapple »

rqtwteye wrote: post #123
ryanSrich wrote: post #107

Earlier quoted context omitted.

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.

The German healthcare system was surprising to me. It was affordable, it was fairly honest, and our anecdotal experience was not as good as most experienced we’ve had in the USA.

A few examples for those wondering: * the total cost for over a week stay was a couple hundred dollars - very affordable! * certain painkillers banned in the USA were the first line of defense there * getting very strong pain killers was next to impossible - I think we probably only got it because we were family members of the anesthesiologist, and he knew we needed it. And it took nearly 24 hours of agonized pain before we could finally get them * nurses are not trained to put in IVs - we needed an MD for that. And the MD had a lot of things to do and we had to wait quite awhile even though there were many nurses around. In the USA, I think most people with the title of nurse can do that

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

#164

Post by stemlord »

eecc wrote: post #92
stemlord wrote: post #59

Earlier quoted context omitted.

I'm fully insured and healthy but still just paid almost $3000 in deductubles for a single upper endoscopy (common procedure for 40+ folks). Cigna. In Italy last summer I received a dental xray and diagnosis as a walk-in, for FREE.

Just adding that in Lombardy, the region around Milan who have a bad case of parochial wanna-be NYC, local (right wing) government is pushing towards private health care with lavish subsidies for privates and a grossly underfunded public health system. To get an MRI via public you can wait 1k days, invia private is a next-day appointment although you must be ready to pay thousands EUR. frankly it’s obviously delibera…

That's disappointing to hear. My experience was in Brescia. I'm from NYC so I can say that if they're charging thousands of euro for a scan they're right on the money.

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

#165

Post by ratg13 »

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…

Once you get rich or in politics, healthcare is no longer a problem, so you don’t see it.

Even this thread is full of Americans trying to tell other Americans that the US system is “better” than Europe

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

#166

Post by stonogo »

b59831 wrote: post #141
jfengel wrote: post #106

Earlier quoted context omitted.

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 arbitra…

> The article suggests... Maybe because it's a politicized topic? How can you smugly dismiss their point like that?

> How can you smugly dismiss their point like that?

Because "it's fine if you're rich" is a shitty place to terminate the matter. It's not a useful counterargument in any sense. Of course it's fine if you're rich, that's why people want to be rich. What about, you know, the rest of the planet?

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

#167

Post by eapressoandcats »

lotsofpulp wrote: post #8

And still Cigna’s profit margins are low single digit percentages. https://www.macrotrends.net/stocks/charts/CI/cigna-group/pro... Wonder what premiums and out of pocket maximums would have to be if there were fewer denials.

For all the crappy stuff insurance does, their medical loss ratio for group insurance is pretty good. The actual problem is that healthcare costs way more in the US than most other countries. Health insurance just ends up getting the blame for that.

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

#168

Post by [deleted] »

EnglishRobin96 wrote: post #138
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.

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…

[deleted]

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

#169

Post by colordrops »

loeg wrote: post #29

> His claim was just one of roughly 60,000 that Dopke denied in a single month last year 60,000 / 20 workdays in a month / 8 hours in a workday => this guy rejected about 375 claims per hour, on average. Over six claims a minute. He spent less than 10 seconds on each claim, for a full month of work time.

This rate is pretty ridiculous. I wouldn't be surprised if there is automated software or a farm of non-medical staff working behind the name of the doctor, similar to how shady contractors will "rent" the license of a legitimate but retired contractor.

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

#170

Post by d1str0 »

theGnuMe wrote: post #124
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.

Know any more details? This seems rather promising.
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