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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

#301

Post by bcrl »

Centigonal wrote: post #108
stouset wrote: post #69

Earlier quoted context omitted.

Counterpoint. I have an Aetna PPO and experienced a stroke last year. $100,000+ hospital stay and insurance just… covered it. I paid $1,100 out of pocket. I had a $100,000+ surgery a few weeks ago to repair a heart issue that may have led to it. They just covered it. No fuss, no hassle. I paid $3,300, which was the remainder of my total annual out-of-pocket, and now I will pay $0 for healthcare for the rest of the ye…

I'm glad you had such a good experience. Not a counterpoint, though. Healthcare is like running water, bridges, or banking systems - a high-volume system with extremely high stakes. We need many nines of consistency as protection against preventable harm. There are around ~35M hospital admissions in the US every year. Even if 9/10 patient experiences are like yours, that means more than 3.5 million people had a sub-p…

My father had a stroke here in Ontario at the beginning of COVID. Total out of pocket costs: $0. This includes 2 ambulance transfers between hospitals because our local hospital didn't have the correct facilities for diagnostic imaging. The only real downside of the system in Canada is that medications aren't covered, but most people get some amount of drug coverage in their employee benefits.

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

#302

Post by thallium205 »

borissk wrote: post #279
thallium205 wrote: post #267

Earlier quoted context omitted.

I’ve worked in healthcare revenue cycle management for over a decade. If you don’t accurately tell the insurance company what you’re doing and why you’re getting denied. Doesn’t matter if it’s health, auto, home, etc. There are thousands of codes, millions of combinations, and all being mostly hand coded by minimum wage workers. There are constant fuck ups most of which don’t require anyone but a computer to review t…

Even if we assume you're right, the way that the system is setup and the fact that there are constant fuck ups, but no effort to fix them are not accidents. Yes, there are conspiracies out there (surprise, most people are not angels) and the US health system is definitely one. Check out the insurance companies profits. Those are directly linked to denied customer claims. Claims are not denied en-mass, by accident obv…

The constant billing and coding fuckups are because the government forces providers to use them. HIPAA requires the use of the x12 standard which is woefully broken. Speech between provider and payer is completely regulated. Nobody is doing anything to address it because they are prohibited by law.

Oh and by the way: health insurance company profits are essentially capped by the government via medical loss ratios. They don’t make more money the more they deny otherwise they will be forced to send rebate checks (like what happened during Covid)

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

#303

Post by dsfyu404ed »

AnIdiotOnTheNet wrote: post #288
djbusby wrote: post #241

Earlier quoted context omitted.

Lawyers, the best way to get reasonable healthcare in USA. What can be done?

I mean, I don't want to say "start shooting them until they get the message that we won't put up with their bullshit", but I honestly can't think of a better plan given that people will find all sorts of excuses to keep voting for the kinds of assholes who prefer it this way. I'd really like to hear one, cause the violence option isn't really very appealing.

This. So, so, so many flavors of the "abuse of the public to make a few bucks" that is codified in the business models and job duties and KPIs of all sorts of organizations is only viable because people bend over and take it. If there was real risk that came with abusing the public employees would either a) not do that part of their jobs b) demand compensation, likely making the abuse not economically worthwhile c) seek other jobs. Any of these cases would force entities who are abusing the public as part of regular business to change their business or bleed out and die.

Or we could just bring back bribing....

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

#304

Post by alphanullmeric »

nobodyandproud wrote: post #292
alphanullmeric wrote: post #268

Earlier quoted context omitted.

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 y…

Law enforcement and military exist to prevent you from using force on others, and others from using force against you. You're absolutely correct, I'm in favour of forcing you to not use force on others. The only positive right I believe in is the enforcement of negative rights.

Alternatively, I simply state that we both agree on law enforcement and military but not healthcare, so at a baseline you want to force others to pay for more things than I do.

I don't support the US healthcare system, but I won't support socialized healthcare because of that. The government can follow the rules it enforces onto private companies by operating its own healthcare service without forcing those that did not choose to use it to pay. Problem?

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

#305

Post by saghm »

duxup wrote: post #239
kwhitefoot wrote: post #235

Earlier quoted context omitted.

> 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.

I thought similarly when reading the part of the article where the legal team said that Cigna's policy wasn't illegal. Maybe it isn't against any laws for the company to do it, but isn't it unethical for doctors to do it? If the law requires that licensed doctors be the ones to review the claims, maybe the most effective way to change this practice is for medical boards to start sanctioning doctors who do this.

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

#306

Post by quickthrower2 »

whatthesmack wrote: post #281
alpaca128 wrote: post #160

Earlier quoted context omitted.

> I paid $3,300, which was the remainder of my total annual out-of-pocket So with insurance you paid more than a European without insurance would, and you call that a counterpoint?

Sure, if GP is in the US and the European is paying 2-3x the income tax rate & earning half the salary.

Depends on the demographic. Moving away from the rich (relatively) HN-er data point is the american in an average earning job much richer than the european after salary difference and tax?

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

#307

Post by anotheraccount9 »

djbusby wrote: post #241
anonuser123456 wrote: post #215

Earlier quoted context omitted.

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?

Seriously consider a universal healthcare. Accept that it will be imperfect, but more balanced and will offer a chance to everyone. Another way to look at it: everyone pays for a healthcare insurance --> everyone gets covered.

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

#308

Post by LBJsPNS »

dsfyu404ed wrote: post #303
AnIdiotOnTheNet wrote: post #288

Earlier quoted context omitted.

I mean, I don't want to say "start shooting them until they get the message that we won't put up with their bullshit", but I honestly can't think of a better plan given that people will find all sorts of excuses to keep voting for the kinds of assholes who prefer it this way. I'd really like to hear one, cause the violence option isn't really very appealing.

This. So, so, so many flavors of the "abuse of the public to make a few bucks" that is codified in the business models and job duties and KPIs of all sorts of organizations is only viable because people bend over and take it. If there was real risk that came with abusing the public employees would either a) not do that part of their jobs b) demand compensation, likely making the abuse not economically worthwhile c) s…

"Or we could just bring back bribing.... "

Oh you sweet summer child...

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

#309

Post by darrin »

thallium205 wrote: post #253

Insurance companies deny medical necessity claims because the procedure and diagnosis code combinations don't align with what is pre-determined to be medically necessary. One of the big reasons why this happens that nobody ever talks about is because the doctors office does not code the claim correctly and it gets denied. The patient is pissed and blames the insurance company, the doctor is pissed and blames the insu…

If all insurance companies published all the code combinations covered for every procedure/diagnosis, I might buy this argument. But they don't. I've asked Blue Cross and they said they don't disclose those details. Many billing codes are open to some interpretation. So if insurance companies aren't transparent about what codes are or are not covered, why are the doctors' offices at fault when something is denied? Why isn't the default response from every insurer "code X isn't covered in combination with code Y. "? Why is it a black box?

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

#310

Post by dilap »

davidw wrote: post #272
djbusby wrote: post #241

Earlier quoted context omitted.

Lawyers, the best way to get reasonable healthcare in USA. What can be done?

Elect people, starting at the local level, who want to change the system? That change doesn't have to be 100% or perfect. The ACA ensured that a lot more people got covered, even if it was not perfect.

Gunna take something a lot more radical than that.
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