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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

#371

Post by stouset »

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?

Yes. I would gladly prefer to live in Europe and benefit from a sane healthcare model.

I don’t and neither do the hundreds of millions of others who remain in the US. So for those people, I wanted to provide a data point that might help them when they, like me, are forced to make decisions about their healthcare in this system.

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

#372

Post by stouset »

danielschonfeld wrote: post #314
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…

And the cost of your Aetna PPO per year? Also this is anecdotal. I too have an Aetna PPO and can tell you of horrid stories and countless hours on repeated phone calls with them. Not saying you just did this (you obv did not) but as a whole in this country we need to start dropping the “it didn’t happen to me so something must be wrong with you” mentality. It is pervasive in the healthcare topic and unfortunately in…

> Also this is anecdotal. I too have an Aetna PPO and can tell you of horrid stories and countless hours on repeated phone calls with them

Please do!

My point was simply to say that this option is one that has done right by me so far. If there is significant evidence this is an outlier experience, I (and I’m sure others) would benefit from knowing so.

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

#373

Post by menage »

lotsofpulp wrote: post #269
menage wrote: post #184

Earlier quoted context omitted.

That's not true. As I discovered when my COBRA ran out recently, finding individual plans that match the coverage of employer plans is very hard or impossible, regardless of how much you're willing to pay.

I’ve always been able to find the same or similar BCBS plan my employers offer on healthcare.gov. If it has the same metal level (platinum/gold/silver/bronze), it should be the same actuarial value. Only thing that Carrie’s

In terms of general benefits, maybe. In terms of provider coverage - I couldn't find an individual plan at coveredca.com that was accepted by doctors at Stanford Hospital.

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

#374

Post by menage »

moate wrote: post #217
menage wrote: post #184

Earlier quoted context omitted.

That's not true. As I discovered when my COBRA ran out recently, finding individual plans that match the coverage of employer plans is very hard or impossible, regardless of how much you're willing to pay.

You’re telling me a mega-corp buying coverage for 10000+ employees might have an advantage in negotiating price that a single “rugged individual” doesn’t?! But that sort of thinking could burst the whole “pull yourself up by your bootstraps” thinking that fuels the American dream! Clearly all individuals (both single citizens and corporate entities)are the same other the law!

Not a question of price, so much as any plan with access to particular doctors/hospitals.

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

#375

Post by dreamcompiler »

geerlingguy wrote: post #361
magila wrote: post #42

Earlier quoted context omitted.

I also have Crohn's and am going through this right now. Months of delays and denials for a new drug lead to two hospitalizations. I'm currently on TPN (IV nutrition) while I taper my Prednisone dose as low as possible prior to surgery. The funny/sad thing is: between my hospitalizations, TPN and related home health care, and surgery, this is all going to cost my insurance far more than the drug they were denying wou…

Exactly my thoughts. I can't believe the calculus here.

It's simple. Some executive gets a bonus soon if he saves the company money right now. Nobody gets a bonus for saving the company money over a 5-year period, and nobody gets punished for costing the company money over a long period either. The incentives are all about the next quarter.

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

#376

Post by dcow »

AnthonyMouse wrote: post #275
dcow wrote: post #126

What would be the problem with requiring all healthcare to be non-for-profit? You can still have it privatized, but you can’t ever be in a situation where you’re trying to maximize profits. Someone poke holes in the idea…

The incentive to maximize profits (i.e. minimize costs and maximize number of customers) is the benefit of a privatized market. The profit-minimizing mechanism is supposed to be competition, because then people switch away from plans that have a poor balance between price and rejecting claims. But because most plans are tied to employers, that part doesn't work. If you had a non-profit with no competition it would be…

I understand what you’re saying but I don't think it’s so simple when you involve human lives. When you have shareholders and a board demanding profits, fucked up things happen like you don’t get the new MRI machine because it’s bad for the bottom line. Or you pass on the state of the art surgical robot because it won’t pay for itself quick enough. Both examples would increase outcomes for patients but don't happen because the board chooses profits. I am from a family of primarily doctors for multiple generations so I have 2nd hand experience with this crap.

I think as a society it would be totally reasonable for us to say “we don't want profiteering in healthcare”. If you set out to take care of people then your business may only cover costs, which includes reinvesting into the business and your employees. You can never be in a situation where you’re weighing profits against patient care because the conflict of interests is considered unacceptable. I would love to see more people advocate for that stance.

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

#377

Post by amai »

Why should a blood test for Vitamin D cost $350?

In Germany blood test for vitamine D are also not covered by the insurance. But they cost 16€. I believe the algorithm might be right in the example given in the text. The costs for such a simple test are excessive and the case should be rejected.

It sounds to me what is described here is simply an algorithm for fraud detection, which many companies use.

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

#378

Post by ThePowerOfFuet »

>As a physician, van Terheyden said, he’s dumbfounded by the company’s policies.

>“It’s not good medicine. It’s not caring for patients. You end up asking yourself: Why would they do this if their ultimate goal is to care for the patient?” he said.

Because their ultimate goal is to make money, as with the entire health "care" system in the US.

Yet another reason blue card trumps green card.

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

#379

Post by colinmorelli »

refurb wrote: post #334
colinmorelli wrote: post #114

Earlier quoted context omitted.

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/

Sure, measurement discrepancies do exist. However, the referenced study is focused almost entirely on Cuba. As a comparison point they use data from PERISTAT which is consistent among countries (or at least that's a goal of the program) for which Sweden is a member.

The point is that, however, you can pick almost any objective health measure and see a similar result. So either all of the measurements are wrong in favor of other nations, or there's a clear problem here.

I think the bigger challenge here is that health in a nation is about much more than just care delivery services. The nations that do better than the US also tend to have significantly greater, and more accessible, social services to the population. Lower income households will have access to higher quality foods, for example. Healthcare services can be rendered even to those who are not actively employed. etc.

Effectively, the US will need to decide if it cares about the health and well being of its population. If it does, we have just about one of the worst ways in modern society to accomplish it. Our method is more expensive, less enjoyable, and has worse outcomes.

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

#380

Post by vobox »

eggsmediumrare wrote: post #297
vobox wrote: post #290

Earlier quoted context omitted.

[flagged]

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.

No "thorough investigation" is being done in the US. European countries have halted this treatment because of a paucity of data and evidence of poor outcomes. But the US just ploughs ahead regardless - perhaps a symptom of its for-profit health care system, each transed kid is worth many $$$ in lifetime treatment. So for legislatures to ban this, is the only reasonable path forward to save kids from this type of medical abuse.
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