Cigna saves millions by having its doctors reject claims without reading them • Hacker News Board

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

#211

Post by kwhitefoot » Sat, Mar 25, 2023, 9:24 PM UTC

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…

> nurses are not trained to put in IVs - we needed an MD for that

That's very odd. Nurses do that all the time in Norway.

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

#212

Post by cmiles74 » Sat, Mar 25, 2023, 9:25 PM UTC

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.

I am fully insured in the United States. An appointment with my primary for something urgent is typically a week out, if I can't wait a week I am advised to go to an emergency room. An appointment with a specialist, if I can get one, is typically six months out. An average emergency room visit is typically a three hour wait to be triaged, additional multiple hours to talk to someone about my condition.

I live in Massachusetts. I would take a public system over what we have now, no questions asked.

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

#213

Post by charles_f » Sat, Mar 25, 2023, 9:25 PM UTC

I somewhat get why you'd build such a system when on the other side you've got pharma and labs pulling for useless medication and tests through doctor presents and "seminars". What's beyond me* is how health insurances get to be the deciding entity when there's such a blatant conflict of interest in the matter, which gets abused as it is here demonstrated.

If you get a home insurance claim, at least here in Canada the insurance company has to use an external adjuster. Even though it's not perfect, it seems a widely better solution to handling claims.

* it's not beyond me, it's probably just the result of lobbying

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

#214

Post by Scoundreller » Sat, Mar 25, 2023, 9:26 PM UTC

arrosenberg wrote: post #82

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 find it hard to believe you have never waited more than 30 minutes in an emergency room. I can't ever remember waiting less and I've always had pretty good insurance.

ERs, even in US, will triage patients by need, not quality/quantity of insurance. If they're seeing insured ankle sprains before uninsured strokes/heart attacks, they're going to get sued to dust.

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

#215

Post by anonuser123456 » Sat, Mar 25, 2023, 9:26 PM UTC

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…

The sneaky thing to do is have your attorney send a letter to the insurance carrier's liability insurance provider, detailing everything you uncover and that they will be on the hook for the malpractice claim. That will get you an highly aggressive advocate with teeth.

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

#216

Post by Scoundreller » Sat, Mar 25, 2023, 9:27 PM UTC

wahnfrieden wrote: post #75

harshalizee wrote: post #23

Earlier quoted context omitted.

I moved from a third world country with both socialized and private healthcare, to the United States. I pay vastly more for worse healthcare than anywhere I've lived. The fact that you, your doctor can agree that a certain procedure is required, only to be denied by a third party with no medical qualification is absolutely dystopian.

Sounds like death panels made up of unqualified bureaucrats

Both public and private systems have "death panels". Though cited article suggests even death panels run by doctors are no guarantee of effectiveness.

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

#217

Post by moate » Sat, Mar 25, 2023, 9:27 PM UTC

menage wrote: post #184

lotsofpulp wrote: post #150

Earlier quoted context omitted.

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.

You’re telling me a mega-corp buying coverage for 10000+ employees might have an advantage in negotiating price that a single “rugged individual” doesn’t?! But that sort of thinking could burst the whole “pull yourself up by your bootstraps” thinking that fuels the American dream! Clearly all individuals (both single citizens and corporate entities)are the same other the law!

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

#218

Post by nobodyandproud » Sat, Mar 25, 2023, 9:29 PM UTC

alphanullmeric wrote: post #136

drowsspa wrote: post #120

Earlier quoted context omitted.

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?

Nothing to do with patriotism, I just question why supporters of collectivism constantly flee to capitalist countries.

Sounds like misplaced patriotism to me.

Not everyone came to this nation due to capitalism. My parents partially came here to be free to say whatever they wanted and not disappear, for instance.

It doesn’t mean healthcare is done right; just as using TP to wipe one’s ass is 100 years backward.

I sometimes wish they stayed back, because my own life and theirs would’ve probably been much better in the long run.

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

#219

Post by thallium205 » Sat, Mar 25, 2023, 9:29 PM UTC

kube-system wrote: post #206

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.

What about prior authorizations?

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

#220

Post by matwood » Sat, Mar 25, 2023, 9:29 PM UTC

winrid wrote: post #79

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 have literally spent years trying to get an MRI for my knee after an accident. Both Kaiser and Anthem won't cover it.

I know it's still not cheap, but I needed an MRI a few years ago and it was $350. Talk to your doctor and let them know you want to pay cash. Mine suggested a place.

Don't get one in the hospital if you can help it. They charge 1-2k because they have a full set of people who can't go anywhere else.