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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

#321

Post by davidw »

explaininjs wrote: post #282
davidw wrote: post #272

Earlier quoted context omitted.

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.

Like Bernie Sanders? Who was then placed in a debate in an “insurance town” where every audience question was some insurance leech complaint that his plan would destroy their jobs? Yeah dude. That’s the point, your job is bullshit and you shouldn’t be doing it. The media also loved to bring on people who “adored their current insurance plan and would hate to lose it”. I’ve never met someone like that in real life, bu…

> If voting could change anything it’d be illegal.

The absolute best way to ensure that nothing changes is to get cynical and try and demotivate anyone else from trying.

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

#322

Post by EnglishRobin96 »

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.

I personally don't understand where these numbers come from. When I moved to Europe, my total tax outlay went down, not up. Aggregating costs across a large pool (everyone in the country) means that I paid less than I did in the US.

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

#323

Post by conductr »

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.

This alone should be grounds for a class action lawsuit. It’s ridiculous they do this in an obviously automated way. If they want to raise the bar on requirements of “submitting a claim “ that’s fine, our healthcare admins can figure it out. But patients should be allowed to be dragged through the mud like this.

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

#324

Post by conductr »

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.

Yep. This may be legal but has to be against the hippocratic oath

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

#325

Post by resoluteteeth »

cscurmudgeon wrote: post #318
resoluteteeth wrote: post #181

Earlier quoted context omitted.

That just shows that the us has good medical treatment for people with essentially infinite money who don't have to worry about cost or insurance coverage so they can bypass the kind of issue the article is talking about entirely. For normal Americans who actually have to worry about these things, healthcare in the us is a nightmare. You can't just ignore insurance and judge the us healthcare system based on the best…

> That just shows that the us has good medical treatment for people with essentially infinite money who don't have to worry about cost or insurance coverage so they can bypass the kind of issue the article is talking about entirely. No, that shows that even in places with public healthcare, there are issues. Universal public health care is not the utopia that its proponents religiously advocate for. > You can't just…

> Most Americans have insurance. You can't ignore real data. Are you from the US?

If you're judging the quality of healthcare based on whether people from the US have insurance or do not have insurance it shows that you're fundamentally failing to understand the type of problem the article is discussing, which in this case is specifically that insurance is broken and insurance companies will refuse to pay for treatment even when people have insurance. The people having Cigna refuse to pay for medical treatments as in the article obviously have insurance or they wouldn't be dealing with Cigna in the first place, so I'm not sure how "real data" on the percentage of americans who are insured could possibly refute that.

> Compared to the rest of the world? It is not.

Yes, US healthcare providers are capable of providing very good care. However, it doesn't matter if the US healthcare providers theoretically provide the best treatment in the world if that treatment is now so expensive and the insurance system is now so broken that a huge percentage of the people can't afford medical treatment even with health insurance (e.g. most americans on bronze/silver health insurance plans).

I think this is something that gets missed in a lot of statistics.

The reality is that once you factor in the insurance system, and not just healthcare providers, the US healthcare system does not look so great anymore for average americans.

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

#326

Post by farmaway »

davidw wrote: post #321
explaininjs wrote: post #282

Earlier quoted context omitted.

Like Bernie Sanders? Who was then placed in a debate in an “insurance town” where every audience question was some insurance leech complaint that his plan would destroy their jobs? Yeah dude. That’s the point, your job is bullshit and you shouldn’t be doing it. The media also loved to bring on people who “adored their current insurance plan and would hate to lose it”. I’ve never met someone like that in real life, bu…

> If voting could change anything it’d be illegal. The absolute best way to ensure that nothing changes is to get cynical and try and demotivate anyone else from trying.

Maybe you're both right.

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

#327

Post by conductr »

ncallaway wrote: post #31

I genuinely think every health insurance denial should have to come from a named doctor at the health insurance company who is personally and professionally liable for the health outcomes from a denial. Deny someone life-saving care without a sound medical reason? That’s a malpractice lawsuit and a potential loss of their medical license.

In a way, a denial is accusing the ordering/prescribing of trying to commit some type of insurance fraud. I agree if you’re trying to override a doctor that knows me, has cared for me, likely already done some labs/scans/etc to make their order, well - the burden should be yours to prove it’s not necessary.

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

#328

Post by bushbaba »

blakesterz wrote: post #5

“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…

Yep happened to me. Worst is when you have two insurance providers and they both claim to be secondary and refuse to pay the bill.

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

#329

Post by bee_rider »

dahfizz wrote: post #278
davidw wrote: post #272

Earlier quoted context omitted.

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.

The ACA just gave more power and money to these same scummy insurance companies.

Yeah, we should have done some single payer system, medicare for all or whatever, but unfortunately we don’t have a very strong left wing in the US.

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

#330

Post by [deleted] »

Qem wrote: post #320
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.

How does one discover what is the insurance carrier's liability insurance provider. Is that public information?

[deleted]
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