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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

#171

Post by bombcar »

indymike wrote: post #37
woohoo7676 wrote: post #3

This has been happening to me for the past several months. 1. Cigna will not tell you for any reason, why the claim is denied 2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial 3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT…

> 1. Cigna will not tell you for any reason, why the claim is denied Of course not. Fight fire with fire. Get care providers to sign a letter to Cigna saying the procedure is medically necessary Going through the process will not work and will go slow. But putting them on notice by having licensed, local care providers say something is medically necessary and urgent will work almost 100% of the time.

And blatantly copy your state's insurance regulatory department. Insurers LOVE that.

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

#172

Post by SkeuomorphicBee »

The USA medical insurance system is missing a "stick" for such bogus rejections. Unduly denying a claim should result in a fine big enough to be felt in the company balance sheet, that is the only way to change companies' behaviours.

, missing some kind of harsh

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

#173

Post by Logans_Run »

Free Market, Self-Regulation, Share-Holder Value.

My Friends, The Revolution is near. There comes a time when the common man can no longer stand idly by and watch as their brothers and sisters (and themselves) continue to be screwed over.

There are many amongst you that fear speaking out in the vain hope that some day that they will get their share of 'the Good Life'. I regret to inform you that if it was going to happen, it would have happened to you by now.

Don't remain silent nor inactive in fear of rocking the boat, the 'they' are mocking you and holding out a carrot on a stick while you blindly plod on in the hope of 'some day'.

Do what you can, when you can. Even the smallest ant can overcome an elephant.

Do not be discouraged nor disheartened if you feel there is nothing you can do. That is what the 'they' count on.

Enough of this Shit!

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

#174

Post by cscurmudgeon »

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.

[flagged]

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

#175

Post by cscurmudgeon »

jfengel wrote: post #106
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.

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…

ProPublica has been known to twist facts. They are not the final word in this.

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

#176

Post by CogitoCogito »

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.

My personal healthcare in Sweden has been higher quality (considering both personal cost and state cost) than my healthcare in US. I have heard complaints the other way of course.

Regardless of our personal experiences, the US spends so an enormous amount on healthcare and gets very little in return by basically all international measurements. Americans who think American healthcare seem to me too insecure to accept that their system is just plain bad. But yes Americans with a lot of money have access to better healthcare than average Americans. That said, this is essentially true in all countries so it's not that relevant really.

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

#177

Post by hotpotamus »

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.

I wonder how many claims a minute GPT4 will be able to achieve?

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

#178

Post by d1str0 »

theGnuMe wrote: post #121
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 w…

I’m not familiar with class-actions, but I assume they would not work well for a class pool that has an extremely wide ranging list of claim value, and background evidence/ailments.

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

#179

Post by d1str0 »

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…

Not trying to be a shill, and would happily discuss my entire healthcare experience with Kaiser, but I highly recommend them if you have the option. Obviously, don’t change unless you do research etc. and again happy to discuss my experience with them for anyone interested.

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

#180

Post by CogitoCogito »

yborg wrote: post #140
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!

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 procedur…

> 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.

I find the American healthcare system pretty atrocious, but I've never had issues getting upfront costs when scheduling non-emergency procedures using cash. Then again it's probably been a good 8+ years since I've done that in the US.

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