Maybe to speed things up patients can opt to have ChatGPT read the claim and make a decision. /s
Cigna saves millions by having its doctors reject claims without reading them
41–50 of 434 posts
Re: Cigna saves millions by having its doctors reject claims without reading them
#42“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…
I have Crohn's disease, and I'm fairly certain dealing with health insurance's ineptitude directly led to multiple hospitalizations and a major surgery last year. Had it not been for their constant denials of a drug I had been on for over two years prior, I might still be taking that medication instead of having developed antibodies for the 6 months they denied. My doctors office gave me free samples as long as they…
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 would have. One would hope this provides them with motivation to better judge the necessity of treatments, but I'm not holding my breath.
Re: Cigna saves millions by having its doctors reject claims without reading them
#43“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…
When someone in my family does not get pre-approved for care, I write a letter and and ask my physician to sign, and ask the other doctors at his practice to sign a letter that goes like this: "I beleive this procedure _____________ is medically necessary for __________. Time is of the essence, and this procedure should be performed as close to immediately as possible." In the signature block, I include the degree, s…
This must have been before insurers adopted the mantra "we aren't denying care, only paying for the care!" With that legal magic wand, there is no risk to the insurer.
Re: Cigna saves millions by having its doctors reject claims without reading them
#44And still Cigna’s profit margins are low single digit percentages. https://www.macrotrends.net/stocks/charts/CI/cigna-group/pro... Wonder what premiums and out of pocket maximums would have to be if there were fewer denials.
If they are paying out huge sums to their c-suite, giving them stock left and right, and enriching the company through stock schemes or dividend payouts, unjustly, perhaps their compensation shouldn't be so rich? https://www.statnews.com/2022/05/12/health-insurance-ceos-ra...
Is their pay out of line with executives in any other similar sized businesses?
As far as I can tell from the financial reports, profit margins are so low simply because expenses are that high, and its across at least 7 publicly listed health insurers.
The main cause of low profit margins that I can tell is high healthcare expenses (and lots of competition and state regulation so they cannot increase premiums more).
Re: Cigna saves millions by having its doctors reject claims without reading them
#45Automatic rejection is a tactic used by all sorts of con artists.
If they say no and you never come back then they don't have to worry about you anymore.
Re: Cigna saves millions by having its doctors reject claims without reading them
#46This has been happening to me for the past several months. 1. Cigna will not tell you for any reason, why the claim is denied 2. Reps will not help at all other than "Oh I see the issue, will reprocess" which often just results in another denial 3. The issue that a helpful rep finally disclosed: Cigna's own claim form for providers has a box that is overloaded for procedure code and equipment code; apparently the CPT…
I always wonder if small claims court could be somewhat viable. In the instances where I’ve fought and gotten approval, I’ve spent my own time, my own money, and had my health deteriorate. Ideally, I’d like to be compensated for the time I’ve spent defending myself to this company, and I’d like some form of remuneration (somewhat for retribution, somewhat as a negative incentive to the company) for my now diminished…
If you have health insurance from your employer, it's probably covered under ERISA. This is federal, so no help from your state insurance agency and no small claims, and I have found that there are few lawyers who will touch it even in a large city.
Re: Cigna saves millions by having its doctors reject claims without reading them
#47I am surprised commenters here did not read into the nuance:
> A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
Before grabbing the pitchforks, it is important to be sure if their policy is reasonable or not. Whose fault is it if doctors ask clients to perform expensive tests, because they can't be bothered to actually think and figure out what test would be the most optimal?
Now even if the doctors really overprescribe tests, I don't think the client should be responsible. Instead, the insurance should pay, but kick the doctor out of their network.
Re: Cigna saves millions by having its doctors reject claims without reading them
#48Privatized 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.
Public health care can be similarly dystopian in other ways: Very long wait times due to limited resources, subpar medical care, limited prescription options and drugs, beauracracy. No matter what society you live, the advice is the same: try not to get sick.
This might be true, but as someone who has lived in the U.S. and Europe I can say utterly unequivocally that I preferred Health Care in Europe. I wasn't even in one of the European countries with a great reputation for Health Care.
Health Care in the U.S. isn't just bad, its outright fucking brutal. An elderly friend of mine recently fell and went to an urgent care where they couldn't get him into the x-ray machine. They told him to go to an emergency room where he waited for _13_ fucking hours with a broken pelvis. I'm basically 100% sure that such emergency room bullshit literally kills people from stress or exposing them to other sick people. You can't even wait in your damn car and just have them text you - they just force you to sit in this horrible room with a ton of sick people for hours on end.
The U.S. Health Care system absolutely fucking blows.
Re: Cigna saves millions by having its doctors reject claims without reading them
#49Earlier 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 ).
> The central government plays a relatively limited role in health care in Denmark.
So the exact opposite of what people usually mean when they say they want public healthcare.
Words mean something.
Re: Cigna saves millions by having its doctors reject claims without reading them
#50Jail the executives.
Revoke the medical licenses of the doctors who rubber stamp the denials.
In addition, states (as the pirnary regulators of insurance) should adopt a rule that if an insurer has a policy which directs, incentivizes, or which managenment knows or should reasonably know results in denials without good faith review, the state then has a cause of action against the insurer for damages of equal to triple the amount originally denied without appropriate review (whether or not later paid), and will, if necessary, pierce the corporate veil to recover it and, separately, each medical reviewer who is found to have denied a claim without good faith review shall be fined an amount equal to the value of claims so denied and prohibited (regardless of whether their medical license may later be restored) from being responsible for medical review of insurance claims in the state in the future.