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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

#181

Post by resoluteteeth »

cscurmudgeon wrote: post #174
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]

That just shows that the us has good medical treatment for people with essentially infinite money who don't have to worry about cost or insurance coverage so they can bypass the kind of issue the article is talking about entirely.

For normal Americans who actually have to worry about these things, healthcare in the us is a nightmare.

You can't just ignore insurance and judge the us healthcare system based on the best hospitals and doctors when most Americans aren't going to have access to that.

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

#182

Post by kube-system »

karmelapple wrote: post #162
rqtwteye wrote: post #123

Earlier quoted context omitted.

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 nex…

In the US people with the title of nurse can be someone who is highly skilled and is playing an important hands-on role in major and complicated surgeries.

I think some other places around the world use the title nurse for what may be a medical assistant in the US. (No clue about Germany though)

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

#183

Post by CogitoCogito »

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, so I’m not convinced it would be better.

Are you basing this fear on any sort of facts or are you just afraid out of ignorance?

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

#184

Post by menage »

lotsofpulp wrote: post #150
ugh123 wrote: post #148

Earlier quoted context omitted.

> a good job that pays for it If that's whats necessary to get decent health care in this country, then something isn't right.

Technically, you just need money to pay for it. However, buying the employer’s choice lets you pay for premiums with pre tax funds, and the employer usually subsidizes 70% of the premiums. So for an individual, it is roughly a $10k per year benefit to get it via employer and for a family of 4, $40k per year benefit.

That's not true. As I discovered when my COBRA ran out recently, finding individual plans that match the coverage of employer plans is very hard or impossible, regardless of how much you're willing to pay.

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

#185

Post by oogali »

glenstein wrote: post #102
KyleJune wrote: post #88

Earlier quoted context omitted.

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.

I am also fully insured and I have never once heard of emergency rooms with an average wait time of 30 minutes in the United States.

I've waited hours in NYC.

I've waited less than an hour in New Jersey and Connecticut.

When I still lived in NYC, I resolved that if I needed a hospital but I wasn't in extremely bad shape, I would drive an hour into an adjacent state's ER rather than wait in NYC.

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

#186

Post by lumb63 »

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…

You cannot know what you will need, but to leap from that and say that you cannot make an informed consumer choice is a huge and incorrect leap.

Actuaries know, in aggregate, what specific demographics will need. Insurance companies use those statistics to make profit. The view that consumers cannot make informed choices on healthcare needs is incompatible with the fact that risks are not perfectly and uniformly random. Unless, by “informed choice”, you mean one that is correct in hindsight, in which case, I agree.

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

#187

Post by avidiax »

SkeuomorphicBee wrote: post #172

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

What if we just don't have a stick. The government or a company they hire is the party that reviews claims. The insurance contacts must have standardized terms and conditions.

This probably wouldn't even really hurt the insurance companies. They would not need to compete with each other by denying claims on the backend to provide lower prices on the frontend.

The current system is a race to the bottom.

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

#188

Post by missedthecue »

eapressoandcats wrote: post #167
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.

I tend to agree. People love to blame insurers for the difference in price between US and (other country) healthcare prices, without any mention of facts like US nurses earning 4 to 8 times as much as an average NHS nurse, or that half a trillion dollars goes to end of life care in the US every year, i.e. spending $70,000 to extend an 85 year life 3 more months.

Income = expenditure. They are one and the same. Every dollar spent on healthcare in the US is someone else's income and looking at the profit margins, 'someone else' doesn't seem to be the insurers.

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

#189

Post by CogitoCogito »

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?

Americans who are unable to listen to critiques of their system are frankly an embarrassment for the country. Their insecurity is kind of pathetic. They hold us back in development as a nation.

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

#190

Post by mertd »

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.

We need to realize that publicized healthcare is the only option. Then we can focus on how to make it more efficient.
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