This country sucks. They’re literally killing us for increased profit margins. It is sickening.
Perfectly legal, will not fix.
Cigna saves millions by having its doctors reject claims without reading them
291–300 of 434 posts
Re: Cigna saves millions by having its doctors reject claims without reading them
#292Earlier quoted context omitted.
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.
You’re always free to go back. Unlike many collectivist countries, we won’t stop you from leaving, or try to force you to do things in general. So it’s not unsurprising that your attempts at forcing others to pay for your things is met with hostility when you and others that share your views don’t even want to face those policies themselves.
> You’re always free to go back. Unlike many collectivist countries, we won’t stop you from leaving, or try to force you to do things in general.
No, I won’t be forced. I’ll just get shouted down by anonymous accounts just like the cancel culture of the left.
You think complacency is patriotism. I actually would prefer to improve my country.
> So it’s not unsurprising that your attempts at forcing others to pay for your things is met with hostility when you and others that share your views don’t even want to face those policies themselves.
“My attempts”? Your response is indeed hostile, but you have it backwards.
My family and I have been directly paying for and subsidizing for your own care and other Federal entitlements for decades.
Your response is also irrational to the core. We collectively pay for law enforcement, the military, highways, etc.
Why is it suddenly taboo to consider whether we’d actually save money if we had a baseline?
Why is the worst of socialized medicine and the worst of market-based medicine an acceptable status quo?
Re: Cigna saves millions by having its doctors reject claims without reading them
#293Why can't healthcare be fixed? I'm self employed, pay a crap ton of money for "good" insurance, and it's horrible. It's very difficult to find good doctors in network. Everything gets rejected from insurance and the Dr has to appeal it multiple times in order to sometimes get them to budge. It's absolutely broken, and even more so for those on individual and family plans (ie not through an employer). Last year I was…
What do you mean by fixed? Affordable? That means we would have to lower medical professional income and we have a shortage of them. Insurance have tried to push down their rates but they just stop taking insurance so we have to pay more to see a decent doctor. We could be more punitive to insurance companies for denying claims but the cost of insurance would become even higher.
There is no easy fix.
Re: Cigna saves millions by having its doctors reject claims without reading them
#294“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…
As long as insurance is subsidized by our tax dollars and is regulated to include (forcefully) everything, then theres no way out.
For the record, to comprehend what this means from the doctors side, this means that Doctors (and billers) must be aware of every possible permutation that is "allowed" for billing by every insurer, for every CPT (procedure code).
I did some quick math to measure:
A) There are ~12000 valid CPT codes. (I could not google the exact number but CPT codes go from 0xxxx to 99xxx, plus therr are also S codes (Sxxxx), J codes (Jxxxx) etc.)
B) There are 155,000 ICD-10 diagnosis codes [1].
There are roughly 900 payors in USA. [2]
This means there are 1.67 x 10^12 rules a doctor billing insurance must know.
Even if you consider the narrow view that a doctor of X specialty may bill only top 100 cpt codes, for maybe 50 payors, thats still a huge number (25M!!!) because diagnosis DX (I.e. ICD-10) is not narrow and requires knowledge of related conditions - billing z11 is different result vs billing z11.26 and you must know that.
Its insane to think anyone will memorize 25 million combinations to know what to bill or not bill. And this calc does not consider modifiers OR primary DX....
[1] https://eohhs.ri.gov/sites/g/files/xkgbur226/files/2021-03/I...
Re: Cigna saves millions by having its doctors reject claims without reading them
#295There's a viral case going around where a doctor whose lost his license due to replacing a hip backwards is now making his living denying insurance claims. It's not just that claims are being denied unread, but when they are read, it's not exactly the medical cream of the crop doing the work.
Re: Cigna saves millions by having its doctors reject claims without reading them
#296Earlier quoted context omitted.
How is that so? The health insurance conglomerates are in private hands.
Parent probably means that those companies are part of a government sponsored cleptocracy.
I would say that there can't be any market without the government creating it (what does a contract or deed mean if there's no authority that recognizes it?), so there's a bit of "no true Scotsman" in trying to call it anything else besides a private market.
Re: Cigna saves millions by having its doctors reject claims without reading them
#297But hey: at least they owned the libs this month by passing a disgusting anti-trans bill. That is what is important right? Not stopping the massive corruption from every mega-corporation in every sector that is making our earth uninhabitable and our lives miserable. Lets hyper focus on people's sexuality.
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Permanent measures should be taken very, very seriously and there should be thorough investigation into long term outcomes. This is not at all what the Republicans care about. They aren't doing this because they care about the health of vulnerable kids. They just don't like trans people.
Re: Cigna saves millions by having its doctors reject claims without reading them
#298Earlier quoted context omitted.
What are some real world examples of beneficial privatized healthcare?
IMHO in privatized healthcare you are not the patient, you are the customer. As such, you should be having a better "customer journey" than in public healthcare: more immediate test/diagnostics, better experience in the hospital (like a room for yourself). And that's it. As a counterpart, it's not clear you are receiving the best medical attention. And of course you (through your employer) are paying for something th…
Would that be Cigna Global Health Benefits?
https://en.wikipedia.org/wiki/Cigna#Cigna_Global_Health_Bene...
From their wiki entry:
"CGHB maintains its own, in-house international claims platform..."
Which may explain your positive experience, compared to their USA customers.
Further, wild speculation here, I'm guessing Spain does more to protect customers, not allowing CGHB to auto-deny claims en masse.
Re: Cigna saves millions by having its doctors reject claims without reading them
#299Earlier 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.
Healthcare in the US can be higher quality, but you never know what you’re going to pay for it. When I was starting my career, I had to go to an ER that was out of network, I checked with my insurance and they said they would cover it. They decided after all not to honor their word and charged me 10’s of thousands of dollars. Being young and independent, this was devastating, despite having a good job, good insurance…
"I checked with my insurance and they said they would cover it. They decided after all not to honor their word and charged me 10’s of thousands of dollars."
That's the insanity here. You simply can't protect yourself reliably from overcharging. Hospitals and insurances do whatever they want and good luck to you fixing mistakes. I find it really hard to understand how people can be defending such a system.
Re: Cigna saves millions by having its doctors reject claims without reading them
#300Earlier quoted context omitted.
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.
> so you’d need to expand HSAs to be large enough to pay insurance premiums
I don't think that's the problem so much as 1) IIRC you simply can't use them for premiums in the first place and 2) you need a high deductible plan to be eligible for an HSA in the first place