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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

#51

Post by sidlls »

lostmsu wrote: post #47

I 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 rea…

I don’t think we should trust the soundness of their algorithm. I’ve worked in the healthcare space before, and the perverse incentives involved should make everyone extremely skeptical of insurance companies’ motivations, procedures, and algorithms.

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

#52

Post by xwdv »

nathan_compton wrote: post #48
xwdv wrote: post #17

Earlier quoted context omitted.

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.…

I’m fully insured and have always been well taken care of in the United States health care system. Never wait more than 30 minutes if I were in an emergency room, and usually I’m attended to within 10-15. Doctors appointments are easy to get, never paid much for prescriptions.

If I was in a public system, I’d fear I’d be fighting for attention alongside the general public, so I’m not convinced it would be better.

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

#53

Post by salawat »

lostmsu wrote: post #47

I 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 rea…

Fuck that.

You know what that incentivizes?

Not testing at all. You know what that leads to? Bad outcomes. I'm all for selection pressure toward more efficacious, less invasive, less dangerous tests. Writing an insurer a blank check to blanket deny millions of claims without checking or reading up though? Nah. That's profiteering.

You want to run that algo in parallel and dift through the claims that would change, individually weeding out the actual false positives? Kosher. Just YOLO'ing it on prod and trottingbit out in front of investors? Hell no.

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

#54

Post by xenospn »

xwdv wrote: post #17
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.

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.

As someone who grew up in israel, I can confirm your statement is factually incorrect.

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

#55

Post by [deleted] »

GiorgioG wrote: post #12
lotsofpulp wrote: post #8

And 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.

15 years ago I worked for a "non-profit" health insurance company that was a Blue Cross Blue Shield affiliate/franchise. The CEO made $2.1m/year while the other VPs were raking in > $1m. The IT organization was as backward as they come - 200+ full time employees. I got in trouble for trying to introduce using source control to their developers. Beyond that, they used Excel spreadsheets as the source of truth for thei…

[deleted]

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

#56

Post by SapporoChris »

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.

"A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments."

"Cigna said its review system was created to “accelerate payment of claims for certain routine screenings,”

This sounds like simple automation with an error rate that is acceptable by Cigna. Of course it's not acceptable to anyone wrongfully denied a claim.

Now that's an issue I don't see in the article. How many claims were wrongfully denied? I can't get worked up about the situation when critical information is missing.

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

#58

Post by lostmsu »

sidlls wrote: post #51
lostmsu wrote: post #47

I 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 rea…

I don’t think we should trust the soundness of their algorithm. I’ve worked in the healthcare space before, and the perverse incentives involved should make everyone extremely skeptical of insurance companies’ motivations, procedures, and algorithms.

From the description it sounded like something trivial. E.g. given the diagnosis, there might be a cheaper known way to get to it. I am a layman, but for instance that could be ordering an MRI when an ultrasound would suffice.

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

#59

Post by stemlord »

xwdv wrote: post #52
nathan_compton wrote: post #48

Earlier quoted context omitted.

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.…

I’m fully insured and have always been well taken care of in the United States health care system. Never wait more than 30 minutes if I were in an emergency room, and usually I’m attended to within 10-15. Doctors appointments are easy to get, never paid much for prescriptions. If I was in a public system, I’d fear I’d be fighting for attention alongside the general public, so I’m not convinced it would be better.

I'm fully insured and healthy but still just paid almost $3000 in deductubles for a single upper endoscopy (common procedure for 40+ folks). Cigna. In Italy last summer I received a dental xray and diagnosis as a walk-in, for FREE.

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

#60

Post by lotsofpulp »

candiddevmike wrote: post #14
OrvalWintermute wrote: post #11

Earlier quoted context omitted.

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...

C-suite, board members, a bunch of "foundations", probably some for-profit contracting services for IT and accounting (also managed by the c-suite, probably). Unraveling health insurance admin costs is probably similar to Panama Papers level of financial engineering, especially after the ACA capped profit margins, the companies just turned to malicious compliance.

If you look at the 10-K for any of the 7 publicly listed health insurers, administrative cost increases are minuscule compared to healthcare expenditures.

You can get rid of half the employees and cut everyone’s pay by half, and it won’t make much difference.

I think the US’s biggest problem in healthcare is liability. Every entity is spending so many resources on making sure that they do not get blamed in the event there is a lawsuit, because the damages are huge.

In countries with taxpayer funded healthcare, this liability issue is much less because you are dealing with the government only and suddenly liability and damage amounts are reduced.

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