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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

#191

Post by globalise83 »

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.

The important question is: have you ever made a large claim for a serious long-term illness? If not, you aren't yet in a position to judge the two systems.

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

#192

Post by lumb63 »

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.

This is the case, and is, IMO, the central problem with American healthcare. Folks in both political parties argue for or against socialized healthcare, and ignore that a huge amount of the problems could be solved by having an actual free market.

My opinion is that providing healthcare as a benefit should be banned. Employees who have healthcare today should be provided the amount the employer would have spent on health care in wages/salary. The fine details are hard to work out, but I think it is a good starting point.

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

#193

Post by CogitoCogito »

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.

Dr. Cheryl Dopke should lose her medical license.

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

#194

Post by Scoundreller »

eric-hu wrote: post #130
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!

Do you know if an American could go to where you are and pay for an MRI and doctors visit out of pocket?

Pretty much, the answer is yes.

Though sometimes the price the consumer pays isn't reflective of the true cost.

Sometimes the public health system does buy/subsidize the machine for the provider and a private client isn't charged some chunk of the amortized cost of the machine because the public system (rightly) assumes that 99% of the work is going to be for their residents. The clinic can profitably just charge for their professional/office use.

Here's a Bucharest Romania MRI clinic with tariffs:

https://rmntineretului.ro/tarife/

It's about 3 Lei to a USD, or US$200-US$500 for an MRI.

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

#195

Post by [deleted] »

cscurmudgeon wrote: post #175
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…

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

[deleted]

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

#196

Post by duxup »

I was on a jury on a civil case that involved medical claims.

The insurance company doctor seemed like a doctor who sort of plodded his way through jobs and eventually just found a place where he could be a doctor and just reject insurance claims.

Dude didn't seem to actually know all the medical claims involved in the case, seemed confused about what kind of care was done ... just not at all on the ball.

When we deliberated and reviewed the evidence absolutely nobody on the jury had any faith in the insurance company's doctor and we disregarded his testimony entirely.

I honestly felt like there should be some consequences for someone acting as a "doctor" testifying in a court case and having very little clue what was going on, but choosing to testify.

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

#197

Post by ClumsyPilot »

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.

Can anyone name any usefull innovation that has come from private health INSURANCE in the past 100 years?

Not private hospitals/drug manufacturers - those are arguable - just insurance. What do they contribute?

They got bailed out in Covid, they take money out of the system in good times, they deny you care in the bad times.

Best I can tell they serve no usefull function

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

#198

Post by Osiris »

My insurance is denying mental health care for my teenager who has Autism. They also rejected prescriptions given by my doctor for reasons that the doctor would already have taken into account.

Both rejections came with a note to “not stop getting care”.

In my opinion, insurance companies should not be able to override a doctor.

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

#200

Post by thallium205 »

Dobbs wrote: post #147
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.

As someone who has lived in the US, UK, and NL. I'll happily take the UK (pre-running it at such a budget that it fell apart) or NL systems over the US anyday. There is no fun surprises like finding out that while your surgeon and hopsital were in-network your anaesthetist was out of network.

“There is no fun surprises like finding out that while your surgeon and hopsital were in-network your anaesthetist was out of network.“

This practice has been outlawed this year.

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