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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

#331

Post by refurb »

hestefisk wrote: post #28
luckylion wrote: post #21

Earlier quoted context omitted.

That won't help you there. Germany's public healthcare system denies plenty of things too, and will only pay for treatment when you sue (or know someone who works there). Germany's private healthcare system on the other hand is usually better (I'm sure there are exceptions and some insurance company that sucks).

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 ).

Every system has a list of approved and unapproved medicines. Every system.

The one benefit (I guess) of universal coverage is that doctors already know the unapproved medicines won't get paid for, so they never try. So you avoid the whole issue of rejections. They just go with whatever the system says it will pay for.

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

#332

Post by xtracto »

I keep and keep saying that health insurance is a scam. Paying to a company for a service when their explicit objective is to AVOID providing that service or to minimize the money they spend is plain wrong.

Even medical professionals are angry at the system (check r/medicine) . We are two parties in a transaction being screwed by a third party which only value is to extract profit as an intermediary... even a lending setup (instead of a insurance) would be better. Or imho better yet, socialized medicine.

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

#333

Post by willcipriano »

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…

The mainstream media also doesn't mention that Americans already spend, on a per capita basis, the most on socialized medicine on the planet. I wonder if it has anything to do with those drug commercials that they play constantly?

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

#334

Post by refurb »

colinmorelli wrote: post #114
marginalia_nu wrote: post #74

Earlier quoted context omitted.

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…

This anecdote may be true, but Sweden has significantly more favorable health outcomes across most dimensions compared to the US. Infant mortality, in-hospital mortality, etc. In fact, most developed nations do. But part of what makes it so difficult to have a productive conversation about healthcare is that everyone has experience with the system in every single country, and bad experiences get passed around. So we…

Infant mortality rates aren't calculated the same in every country. I have no idea if Sweden does it differently than the US, but Cuba's low infant mortality compared to other Central American countries disappears when you calculate them all the same way.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681443/

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

#335

Post by IG_Semmelweiss »

kurthr wrote: post #61
anigbrowl wrote: post #27

Earlier quoted context omitted.

Standard answer is we can't tell you why you were rejected How did you find out about the automatic rejection/identity of the reviewers?

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…

Actually this is a hard way.

All it takes is a last name. You dont even need a first name or state I believe, although you may need a lot of patience and some luck to find the right "smith" without a state. Once you have at least a last name, you could look up the doctors specialty even practice address in the public NPES system.

Good for you though! Never though non surgeons would review surgery claims. Seems insane to me and grounds for a professional liability suit

You do need access to the state board if you want to check out complaints. i dont think You will find much though. Doctors rarely get "written up"

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

#336

Post by Jensson »

xtracto wrote: post #332

I keep and keep saying that health insurance is a scam. Paying to a company for a service when their explicit objective is to AVOID providing that service or to minimize the money they spend is plain wrong. Even medical professionals are angry at the system (check r/medicine) . We are two parties in a transaction being screwed by a third party which only value is to extract profit as an intermediary... even a lending…

Problem is that neither the patients nor the doctors choose health insurance so they both get screwed over. Your company CFO chooses your health insurance and the hospital managers chooses what health insurances to collaborate with.

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

#337

Post by engineer_22 »

xtracto wrote: post #332

I keep and keep saying that health insurance is a scam. Paying to a company for a service when their explicit objective is to AVOID providing that service or to minimize the money they spend is plain wrong. Even medical professionals are angry at the system (check r/medicine) . We are two parties in a transaction being screwed by a third party which only value is to extract profit as an intermediary... even a lending…

Government intervention is clearly necessary, but having government take over the industry is obviously the most drastic step we can propose.

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

#338

Post by meetingthrower »

alpaca128 wrote: post #160
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 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?

Right, and also the actual cost of the insurance which is about $20k per family of four per year. That cost will be born by the employer, partly by the employee, or by the taxpayer via aca subsidies.

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

#339

Post by roenxi »

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.

Is "not perfect" strong enough criticism if people are being covered by services that do nothing? Today's article is saying that that large insurers might just be rejecting claims without reading them. Without the ACA, presumably money wouldn't be being spent on companies that literally just take the money for compliance reasons then don't provide a service.

This is one of the more annoying failure modes of socialised medicine; when things go wrong the consumer has no control over the waste because they aren't in control of the money being spent.

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

#340

Post by flangola7 »

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.

It got rid of pre existing conditions and the lifetime pay cap. That saved people, including me.
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