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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

#241

Post by djbusby »

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.

Lawyers, the best way to get reasonable healthcare in USA.

What can be done?

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

#242

Post by thallium205 »

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.

So then what are your thoughts on those who get denied on a Medicaid plan?

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

#243

Post by anakaine »

tstrimple wrote: post #210
Jcowell wrote: post #110

Earlier quoted context omitted.

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. “A…

If that isn't the best summary of what I feel the conservative American psyche is at large, then I don't know what is.

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

#244

Post by cmiles74 »

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.

IMHO, the push-and-pull between insurance companies and hospitals is a big problem here. They seem to be in a co-dependent battle to consistently raise the costs of everything. I don't think any solution to managing cost will succeed unless we're altering the incentives for both insurance companies and hospitals.

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

#245

Post by wahnfrieden »

Scoundreller wrote: post #216
wahnfrieden wrote: post #75

Earlier quoted context omitted.

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.

The article is not about death panels run by doctors, they are run by insurance companies. The doctors in this scenario are workers given bounded instructions on how to operate by the ones running it, without autonomy on how to organize the death panel decisionmaking. It's in the title - the "having" shows who is in control. These are not worker owned cooperatives. Nor are most state owned death panels.

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

#246

Post by kwhitefoot »

speedgoose wrote: post #227
hestefisk wrote: post #28

Earlier quoted context omitted.

You can have good public healthcare without the need of the notion of 'claims'. The Scandinavian healthcare system is a good example ( https://en.wikipedia.org/wiki/Healthcare_in_Denmark ).

The Norwegian public healthcare is great. The default recommendation to most health issue is to do more sport. Being very physically active usually helps, so it’s not a bad recommendation. You may experience more pain compared to some other healthcare systems. Like France from my experience and probably USA from what I read. I had some unforgettable experiences in Norway, such as a colonoscopy without sedation or ana…

> I had some unforgettable experiences in Norway, such as a colonoscopy without sedation or anaesthesia in case I can tolerate the pain.

What pain? I have had a colonoscopy without any sedation, also in Norway. It was uncomfortable, occasionally very, but I wouldn't have called it painful. I think you must have encountered an incompetent doctor.

Can't imagine why you would want general anaesthesia unless it was strictly necessary as it gives an additional risk of dying.

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

#247

Post by ridgeguy »

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??

"We" don't choose.

America's health care system is shaped and maintained by those who benefit economically from its configuration. Configuration maintenance tools include lobbying, gerrymandering, targeted tax favors, and wide dissemination of misinformation.

It's a very small fraction of "we" that maintains this status quo.

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

#248

Post by kube-system »

thallium205 wrote: post #219
kube-system wrote: post #206

Earlier quoted context omitted.

That doesn’t make any sense. Insurance claims are submitted to insurers after providers have already performed the care.

What about prior authorizations?

The article is about claims, which are a difficult thing than pre-auths.

There are some restrictions on pre-auths and when an insurer can require one. If you are in need of immediate care to save your life, they are not required and your provider will give you care before even telling your insurance company about it.

The grey area with pre-auths is with nonemergency care that could lengthen someone’s life. There are requirements by law for appealing these denials but yes, this is where those stories about “I can’t get my cancer treatment” come from.

This is not the situations in the article, though.

What’s shitty about the actions in the article is that many people don’t even realize that erroneous health insurance denials are common and they just accept the denial and pay out of pocket. It is very common to get a denial, send in a challenge like “no this should be covered” and then they pay.

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

#249

Post by nine_zeros »

Centigonal wrote: post #98
geerlingguy wrote: post #22

Earlier quoted context omitted.

I have Crohn's disease, and I'm fairly certain dealing with health insurance's ineptitude directly led to multiple hospitalizations and a major surgery last year. Had it not been for their constant denials of a drug I had been on for over two years prior, I might still be taking that medication instead of having developed antibodies for the 6 months they denied. My doctors office gave me free samples as long as they…

Situations like this are infuriating to me. Our healthcare system needs to have some kind of provision for "this patient needs to be on treatment X probably for life. They are authorized for this treatment and subsequent claims will be approved unless there is a qualifying event (e.g. a recall, condition changes, patient and their doctor switch treatment, etc)." I have UC that's well-controlled with mesalamine, and I…

Here's a simple solution. Insurance HAS to pay if a doctor recommends it. This is what premiums are for. If insurance cannot pay, they can go out of business.

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

#250

Post by kwhitefoot »

marginalia_nu wrote: post #74
hestefisk wrote: post #28

Earlier quoted context omitted.

You can have good public healthcare without the need of the notion of 'claims'. The Scandinavian healthcare system is a good example ( https://en.wikipedia.org/wiki/Healthcare_in_Denmark ).

Eh, my experience with health care in Sweden last couple of years is that almost no matter what your issue is, they'll ask what meds you are on, take your blood pressure, and some token blood samples and send you home. This costs $20. This process obviously does nothing to alleviate any medical issue, so you come back a few weeks later. You pay your $20. New doctor this time, who asks what meds you are on, takes your…

> you come back a few weeks later. You pay your $20. New doctor this time,

That's odd. Here in Norway I can always see the doctor with whom I am registered. Very occasionally I'll accept seeing a different doctor in the same practice because that can mean getting an appointment sooner.

I think you should complain to someone because you are clearly getting substandard care.

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