Maybe to speed things up patients can opt to have ChatGPT read the claim and make a decision. /s
it would probably benefit patients
AIs are wrong at least some of the time... That means they will approve some claims. Not deny all of them.
Cigna saves millions by having its doctors reject claims without reading them
71–80 of 434 posts
Re: Cigna saves millions by having its doctors reject claims without reading them
#72Earlier 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.
I moved from a third world country with both socialized and private healthcare, to the United States. I pay vastly more for worse healthcare than anywhere I've lived. The fact that you, your doctor can agree that a certain procedure is required, only to be denied by a third party with no medical qualification is absolutely dystopian.
I also came to the US from a country with a good hybrid public/private system and my experience in the US had been different.
So I guess it depends on where (city/state) you live and also what type of insurance you have.
Where I live I have access to a SOTA network of hospitals with great technology and some practices amount the best in the world (people come here from other states and even countries for treatment) and I use their own insurance, so it's been great so far, never dealt with any issues having medical care rejected.
I pay $350/month (self employed) and I have a very reasonable deductible, $60 copay to see specialists and many preventive procedures such as cancer and heart disease screenings (which I use), blood work and some PT sessions completely free.
I even get discounts on fitness centers and health tracking apps which helps offset part of the premium.
My shoulder was actually spared from a very invasive surgery thanks to a doctor top of his field (he sees olympic teams) who was able to treat me with only PT.
I don't think I paid more than $1000 out of pocket for everything including several MRIs and multiple visits to his practice, plus several sessions of PT and medications.
It could have been free back in my country, I guess, but I could have also been screwed for life due to an unnecessary surgery.
Re: Cigna saves millions by having its doctors reject claims without reading them
#73Why can't healthcare be fixed?
I'm self employed, pay a crap ton of money for "good" insurance, and it's horrible. It's very difficult to find good doctors in network. Everything gets rejected from insurance and the Dr has to appeal it multiple times in order to sometimes get them to budge. It's absolutely broken, and even more so for those on individual and family plans (ie not through an employer).
Last year I was with United Healthcare, this year Blue Cross blue shield. Both are horrible. Both are massive companies.
Re: Cigna saves millions by having its doctors reject claims without reading them
#74Earlier 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 ).
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 blood pressure and orders the same tests.
Obviously testing the same thing a second time didn't further the investigation. So you go back. You pay your $20. Yet another doctor this time, who asks what meds you are on, takes your blood pressure and orders the same goddamn tests.
Rinse and repeat. I've had like five of these contacts the last few years. Starting to look like a heroin junkie from all the blood samples. I've never learned of any test results. Just keep taking the same tests over and over. There is just zero continuity.
Re: Cigna saves millions by having its doctors reject claims without reading them
#75Earlier 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.
I moved from a third world country with both socialized and private healthcare, to the United States. I pay vastly more for worse healthcare than anywhere I've lived. The fact that you, your doctor can agree that a certain procedure is required, only to be denied by a third party with no medical qualification is absolutely dystopian.
Sounds like death panels made up of unqualified bureaucrats
Re: Cigna saves millions by having its doctors reject claims without reading them
#76Privatized 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.
All claims being reviewed by big health insurance conglomerates is the antithesis of privatized healthcare. It incorporates the worst part of public healthcare and destroys the best potential benefit of privatized healthcare.
How is that so? The health insurance conglomerates are in private hands.
Re: Cigna saves millions by having its doctors reject claims without reading them
#77“Put yourself in the shoes of the insurer,” Howrigon said. “Why not just deny them all and see which ones come back on appeal? From a cost perspective, it makes sense.”
Something about "do no harm" comes to mind.
Re: Cigna saves millions by having its doctors reject claims without reading them
#78Earlier 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.
Only ~8% of people are uninsured so I wouldn't be so quick to distance yourself from being "the general public". Besides, you don't need insurance to be stabilized in an ER that only comes into play after (or if you enter with a non-emergency). 30 minutes is pretty good though, especially if it's the latter type of visit, it'd be about 3x better than the best state average https://www.beckershospitalreview.com/rankings-and-ratings/e.... Specific location and severity have more to do with ER wait times than your insurance. Travel can often be a "spin the wheel" type situation. I'm lucky to have short wait times near where I live but on some work trips I haven't been so lucky.
Re: Cigna saves millions by having its doctors reject claims without reading them
#79Privatized 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.
I have literally spent years trying to get an MRI for my knee after an accident. Both Kaiser and Anthem won't cover it.
Re: Cigna saves millions by having its doctors reject claims without reading them
#80Privatized 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.
All claims being reviewed by big health insurance conglomerates is the antithesis of privatized healthcare. It incorporates the worst part of public healthcare and destroys the best potential benefit of privatized healthcare.
What are some real world examples of beneficial privatized healthcare?