31–40 of 434 posts
Deny someone life-saving care without a sound medical reason? That’s a malpractice lawsuit and a potential loss of their medical license.
This is the reason we need universal public healthcare.
> 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.
Blanket denial without consideration lowers your costs as an insurance provider, because it acts like a filter on people who care enough to appeal repeatedly.
Jail the executives.
“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…
"I beleive this procedure _____________ is medically necessary for __________. Time is of the essence, and this procedure should be performed as close to immediately as possible."
In the signature block, I include the degree, specialty and medical school of the doctor. I then fax the letter in, and within 30-40 minutes, I have a phone call apologizing for rejecting and giving me pre-approval for the care. I learned about this when my (at the time) 15 year old was rejected for a cardiac procedure and the billing person pulled out a pre-printed deck of letters that was pre-signed by every department head at the hospital. The one thing the insurance people fear most is risk.
This has been happening to me for the past several months. 1. Cigna will not tell you for any reason, why the claim is denied 2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial 3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT…
Of course not. Fight fire with fire. Get care providers to sign a letter to Cigna saying the procedure is medically necessary Going through the process will not work and will go slow. But putting them on notice by having licensed, local care providers say something is medically necessary and urgent will work almost 100% of the time.
> 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.
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.