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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

#201

Post by ClumsyPilot »

kurthr wrote: post #13
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…

Wife is a nurse. Required surgery for lifesaving/severe disability (inherited congenital, killed her father). Insurance was Aetna and Hospital Self Insured. Surgery recommended by world class surgeon she worked with. Finally pre-approved on 3rd appeal after 8 months and 150pages of documentation of every piece of every single communication (who, when, response, expected next contact) only weeks before surgery schedul…

> Standard answer is we can't tell you why you were rejected (code only) because the criteria are from a third party and their review document is proprietary

So you paid for a service, and you don't get the service you paid for, and you will not be told why?

If I did this in my line of work, I would be in prison for fraud.

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

#202

Post by mavelikara »

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.

> Sure I'm lucky to have a good job that pays for it,

That is not where you are lucky.

You are lucky to be healthy enough that you can hold on to that job. Once your health takes a bad turn, and you are unable to work, when you really need your healthcare, that's when you are better positioned to judge the quality of healthcare.

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

#203

Post by Scoundreller »

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.

Everywhere and nowhere it can be 30 minutes. Every competent ER on the planet triages patients. Come in with crushing chest pains and it should be 30 minutes everywhere 99% of the time. Broken arm? You might wait hours if people keep coming in with crushing chest pains.

"Wait" can be defined very differently. Wait time to get triaged by a nurse? An ECG for chest pains? Initial physician assessment? Entry-to-exit? Lab results? Time to X-Ray if needed?

Lots of directives may be in place too. In an efficient system, the nurse is empowered to "order" many procedures that screen out serious things that require immediate physician intervention. Or just to save time like ordering an X-Ray first instead of waiting to see a doctor to order it and then waiting again for it to come back to review.

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

#204

Post by thallium205 »

glenstein wrote: post #99
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.

What part of public healthcare is incorporated into health insurance conglomerates? And what potential benefits of privatized healthcare are we missing out on?

Who do you think run all state level Medicaid programs? Government employee health plans? Private conglomerates.

That’s one of many many examples.

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

#205

Post by nobodyandproud »

oogali wrote: post #185
glenstein wrote: post #102

Earlier quoted context omitted.

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.

Call 911 and get an ambulance.

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

#206

Post by kube-system »

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.

That doesn’t make any sense.

Insurance claims are submitted to insurers after providers have already performed the care.

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

#207

Post by Someone1234 »

lumb63 wrote: post #192
casenmgreen wrote: post #146

Earlier quoted context omitted.

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 he…

I agree, an important component though is that insurance premiums are pretax, so you’d need to expand HSAs to be large enough to pay insurance premiums.

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

#208

Post by thallium205 »

avgDev wrote: post #122
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!

Because in US MRI is $1000 to $8000. It is a joke.

$550 for an MRI.

https://tellicaimaging.com/

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

#209

Post by kurthr »

anigbrowl wrote: post #70
kurthr wrote: post #61

Earlier quoted context omitted.

That is a good question. The first appeal was "free" so we didn't have to justify it with anything other than, "no really the surgery is necessary". They only gave us a rejection number on the second and third rejections and we had to request the written forms by mail, which took weeks. The written form didn't have much more, mostly boiler plate, but it did have the number (and maybe a chapter/paragraph number citati…

Good grief. I'm sorry you had to go through that, the bureaucratic trauma involved in health billing/insurance increasingly seems as bad as or worse than the medical issue itself.

It was definitely a learning experience. If you're in the hospital under a doctor's care it's a lot easier, but if you have major (expensive) preventative care, then the insurers want to discourage or delay that as long as possible.

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

#210

Post by tstrimple »

Jcowell wrote: post #110
kurthr wrote: post #61

Earlier quoted context omitted.

That is a good question. The first appeal was "free" so we didn't have to justify it with anything other than, "no really the surgery is necessary". They only gave us a rejection number on the second and third rejections and we had to request the written forms by mail, which took weeks. The written form didn't have much more, mostly boiler plate, but it did have the number (and maybe a chapter/paragraph number citati…

How on earth can some one read this and think that the American Health System isn’t fucked up? Can someone explain to me why the model we choose to pay for the health for the populous of this country is through insurance and not straight up taxes??

Because it works well enough for them now, and they seem to have no capacity to either understand or care that others are suffering under the same system. For some, the demand for maintaining the status quo is far more cruel.

https://www.bostonreview.net/articles/jonathan-m-metzl-dying...

> Even on death’s doorstep, Trevor was not angry. In fact, he staunchly supported the stance promoted by his elected officials. “Ain’t no way I would ever support Obamacare or sign up for it,” he told me. “I would rather die.” When I asked him why he felt this way even as he faced severe illness, he explained: “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.”

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