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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

#381

Post by dennis_jeeves1 »

fzeroracer wrote: post #363
dennis_jeeves1 wrote: post #319

Earlier quoted context omitted.

A true free market is when anyone should be allowed to practice medicine including your barber. That would give your regular doctor a run for their money and have them perform better that the barber. Similar goes for pharmaceuticals, a true free market does not exist.

This already exists and we know what the outcome of it is. It's alternative medicine. Insurers will gladly and gleefully let you do holistic woo bullshit because it saves them money. A 'free market' as you state just results in people falling for bullshit care.

>This already exists and we know what the outcome of it is.

No, you cannot prescribe mainstream drugs (some of it which are indeed useful) if you are not licensed. Cannot do surgery etc, either. All of it is 'illegal'.

>A 'free market' as you state just results in people falling for bullshit care.

True, what's different now?

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

#382

Post by eggsmediumrare »

vobox wrote: post #380
eggsmediumrare wrote: post #297

Earlier quoted context omitted.

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 medi…

That could all very well be true, but in that case it feels like most Republican lawmakers have arrived at the right conclusion by accident.

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

#383

Post by paledot »

willcipriano wrote: post #333
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…

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?

By my understanding, that's the most on health care. This includes private insurance premiums, which is why the "we like private because it's cheaper" argument doesn't hold water.

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

#384

Post by kevviiinn »

nobodyandproud wrote: post #205
oogali wrote: post #185

Earlier quoted context omitted.

I've waited hours in NYC. I've waited less than an hour in New Jersey and Connecticut. When I still lived in NYC, I resolved that if I needed a hospital but I wasn't in extremely bad shape, I would drive an hour into an adjacent state's ER rather than wait in NYC.

Call 911 and get an ambulance.

That's a good way to spend $6000

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

#385

Post by theGnuMe »

sveiss wrote: post #349
theGnuMe wrote: post #251

Earlier quoted context omitted.

>Insurance was Aetna and Hospital Self Insured Does this mean that the hospital self-insured and provided the surgery? As in why have Aetna involved at all then?

This is common for medium or larger companies. Instead of paying monthly insurance premiums, the company directly funds the claim payments as they come in. They outsource the work of adjudicating claims, negotiating with providers/facilities, cutting checks, setting approval criteria and first level appeals to another company, called a Third Party Administrator. Now, who happens to have all the skills and expertise t…

Right but here the self insurer is the hospital doing the procedure. So you’d think it would just take the loss.

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

#386

Post by willcipriano »

paledot wrote: post #383
willcipriano wrote: post #333

Earlier quoted context omitted.

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?

By my understanding, that's the most on health care . This includes private insurance premiums, which is why the "we like private because it's cheaper" argument doesn't hold water.

Nope, the US government spends the most on socialized medicine.

The "We need to raise taxes to have universal coverage" argument doesn't hold water.

https://data.oecd.org/healthres/health-spending.htm

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

#387

Post by magila »

dreamcompiler wrote: post #375
geerlingguy wrote: post #361

Earlier quoted context omitted.

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.

It still doesn't make sense. This whole ordeal has taken place over about 6 months. If anything, forcing me down the surgery route has pulled their costs forward in time, not pushed them back.

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

#388

Post by kevviiinn »

ClumsyPilot wrote: post #197
dafelst wrote: post #7

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.

Can anyone name any usefull innovation that has come from private health INSURANCE in the past 100 years? Not private hospitals/drug manufacturers - those are arguable - just insurance. What do they contribute? They got bailed out in Covid, they take money out of the system in good times, they deny you care in the bad times. Best I can tell they serve no usefull function

Capitalism is all about rent seeking and having middle men that contribute nothing where they only exist to suck money and resources out of the system

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

#389

Post by throw737away »

olliej wrote: post #341
throw737away wrote: post #316

Earlier quoted context omitted.

That is sick. I'm sorry. I remember that town hall. I know people at evicore. Some of them even seem to take pleasure in the fact that patients and doctors call them EvilCore. They're very convinced that evicore delivers superior outcome at lower cost. I quit Cigna late last year. Couldn't take the place anymore.

> They're very convinced that evicore delivers superior outcome at lower cost. A superior outcome by what measure? Non-treatment with a cheaper life insurance payout than cost of treatment is "superior". Treatment with a worse long term outcome that is cheaper overall is "superior".

Insurance companies' primary master is always the payor. Always.

They talk about serving the patients, but payors are who pay the bill.

"Superior outcome" = Careful dance between aggregate average outcome vs total cost of care. It's a typical insurance industry doublespeak, and an very effective way to sell to payors.

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