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

#231

Post by kwhitefoot » Sat, Mar 25, 2023, 9:36 PM UTC

CogitoCogito wrote: post #193

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.

Her employer should be jailed as well, all the way to the top of the company. Such behaviour cannot exist without at least the tacit agreement of everyone higher in the chain of command.

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

#232

Post by prh8 » Sat, Mar 25, 2023, 9:37 PM UTC

ClumsyPilot wrote: post #201

kurthr wrote: post #13

Earlier quoted context omitted.

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.

This is literally how it works in the US, this is not the exception

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

#233

Post by Amezarak » Sat, Mar 25, 2023, 9:39 PM UTC

Timon3 wrote: post #89

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.

Don't you think it's a worthy goal to strive for this for all people in your country? Would you really try to block progress towards that goal due to your fear of being treated as they are right now, instead of putting your energy towards nobody being treated that way? Sincerely, if anyone can explain to me - how can we as a species both have figured out game theory, AND consider this as a position that is in any way…

The best insurance I've seen in the US is Medicaid.

It's people in the middle who are getting squeezed by HDHPs, mostly not the poor, who have access to Medicaid (exact qualifications vary by state) or Medicare (everyone 65+).

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

#234

Post by theGnuMe » Sat, Mar 25, 2023, 9:39 PM UTC

d1str0 wrote: post #170

theGnuMe wrote: post #124

Earlier quoted context omitted.

There's some doc on twitter who was denied by insurance and he filed a board complaint against the insurance doc claiming malpractice. I think he won.

Know any more details? This seems rather promising.

https://twitter.com/generalorthomd/status/163207481637850726...

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

#235

Post by kwhitefoot » Sat, Mar 25, 2023, 9:39 PM UTC

duxup wrote: post #196

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 del…

> 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.

It will make no difference. It is the people higher up and the investors in the company who are responsible. The doctors in question don't behave as they do just because they want to, they do it because that is what the company that employs them demands.

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

#236

Post by woohoo7676 » Sat, Mar 25, 2023, 9:39 PM UTC

Kye wrote: post #6

kurikuri wrote: post #4

Earlier quoted context omitted.

I always wonder if small claims court could be somewhat viable. In the instances where I’ve fought and gotten approval, I’ve spent my own time, my own money, and had my health deteriorate. Ideally, I’d like to be compensated for the time I’ve spent defending myself to this company, and I’d like some form of remuneration (somewhat for retribution, somewhat as a negative incentive to the company) for my now diminished…

There needs to be something like the CFPB for health care. I couldn't get an actual human to acknowledge me when dealing with PNC when they ate up my bank, but one CFPB complaint got them to do exactly what I asked. That way you never get to the point of burning time, money, and health because they're afraid of action from the agency.

Great idea - agreed we need an agency to go to that has some teeth, as the insurance co's will never be afraid of individuals.

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

#237

Post by smsm42 » Sat, Mar 25, 2023, 9:39 PM UTC

Imagine spending years studying medicine and ending up doing this.

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

#238

Post by mdorazio » Sat, Mar 25, 2023, 9:40 PM UTC

xwdv wrote: post #153

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.

Post COVID hospital in Ohio, limped in with severe ankle sprain, got doctor in less than 15 minutes and out within an hour with splint and crutches. Even got X-Ray.

What city? Most of us in this thread live in larger cities. When I lived in LA and had to go to the ER, the wait was 5 hours and they literally rolled a cart over and made me prepay my insurance deductible (several hundred dollars) before a doctor even saw me. Helped a friend get to the ER in Phoenix and it was about 3 hours.

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

#239

Post by duxup » Sat, Mar 25, 2023, 9:40 PM UTC

kwhitefoot wrote: post #235

duxup wrote: post #196

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 del…

> 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. It will make no difference. It is the people higher up and the investors in the company who are responsible. The doctors in question don't behave as they do just because they want to, they do it because that is what the company that employs them demand…

I'd like to see the doctor be at least at risk of losing his license. It's a serious profession and should be held to standards.

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

#240

Post by ridgeguy » Sat, Mar 25, 2023, 9:41 PM UTC

anonuser123456 wrote: post #215

kurthr wrote: post #13

Earlier quoted context omitted.

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.

This is excellent advice, and isn't restricted to the medical arena.

Corporate counsel for insurance companies comprise one of the very few spots on the brontosaurus with low-latency innervation from the brain. Poke it, you'll usually get a response that will arrive faster than the usual appeals processes.