How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

This article first appeared at ProPublica and The Capitol Forum. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.


This is a companion discussion topic for the original entry at https://talkingpointsmemo.com/?p=1452398

For profit health insurance is a Crime Against Humanity.

25 Likes

For profit baby, for profit. The profit in insurance comes from denying coverage at every turn.

15 Likes

Thanks for posting this article.

The sheer greed of Cigna and other large insurers is not that hard to understand. What is hard to understand is how any doctor could be following their oath as a medical practitioner to basically deem so many procedures and tests, etc, as not medically necessary…without ever having actually reviewed the claims in any detail.

11 Likes

I am about to not have a Cigna prescription drug plan. I have yet to get a prescription drug refill that wasn’t cheaper using GoodRx than my Cigna plan.

6 Likes

Recently Aetna partly denied payment for my dental procedure that they had pre-approved. I grumbled and wrote a check. I think most people don’t have the ability to win a fight against an insurance company. The numbers they put in their statements don’t even make any sense.

7 Likes

These people suck ass.

10 Likes

I knew an RN who worked for an insurance company, denying legitimate claims. She quit after a year, unable to live with her conscience. Good to know now that a conscienceless algorythym is available to do her job. /s

7 Likes

Hmmmm… just results in denial of payment… so denial of insurance that the employee paid for.

10 Likes

Never give up on a claim. The squeaky wheel gets the grease.

The mother of my kids worked on these f*ckers for 6 months to get our kid surgery she needed, and she finally wore them down. Now the kid is in great shape, a month of healing later.

0ed90e42-0e0a-4f09-bf8f-5cb14161c385_text

16 Likes

Why would they do this if their ultimate goal is to care for the patient?” he said.

I’m still laughing that he thinks a for-profit healthcare system might have an ultimate goal to care for the patient.

It’s ultimate goal is … profit!

16 Likes

FTFY. (Note: That’s not saying doctors shouldn’t get paid. Though of course, nobody should get paid, we should get past the monetary economy entirely into a glorious socialist worker’s paradise, but that’s not gonna happen for at least half a dozen tech jumps yet.)

4 Likes

totally O/T FYI
Trump Deletes Post That ‘Threatens’ DA Alvin Bragg (mediaite.com)
The Drudge Report, Matt Drudge’s right-leaning news aggregator ran a headline on Friday declaring former President Donald Trump threatened Manhattan DA Alvin Bragg in a Thursday Truth Social post, which Trump deleted on Friday afternoon.

On Thursday, Trump shared a link with a split-screen image of him holding a bat on one side with an image of Bragg’s head on the right.

Drudge’s headline on the post read, “PSYCHO DON!”

“THREATENS MANHATTAN DISTRICT ATTORNEY,” read the second line of the headline.

5 Likes

I have an expensive John Hancock Long-term Care Plan. Its very expensive–$2,300 per year–for someone with limited income like me. I’ve been paying for twenty years already. I too often think that I will die before accessing one penny or when I’m in need, they will find an excuse to deny.

Also people are living longer, so every third year JH appeals to the state and always gets substantial raises to the rates. They’ve offered to buy us out for what we’ve put into it, with not one penny for inflation or interest given that they’ve had use of my money for all those years already. Now I understand why John Hancock can have a huge fancy building and can afford to put its name on so many high-end sporting events and facilities. I hate them.

7 Likes

First do no harm.

3 Likes

The job of insurance companies is to make money and the easiest way for them to do it is too take your money and not provide necessary medical care. How those doctors running computer programs to deny coverage can look themselves in the mirror and not see a crook looking back at them is more than I can understand.

6 Likes

Crook and then some — abject failure of humanity.

1 Like

Just came to say that for profit health insurance is immoral but i like your wording better!

5 Likes

Sounds like a class-action lawsuit just waiting to happen…

3 Likes

I’d guess it’s not hard to incentivize that behavior. Since it’s trivial to deny, all that’s needed is that it be more time consuming to approve and also to base performance on number of claims processed per unit time. Add to that dismissals of anyone who takes too long to process claims and you select for the behavior you want as well as incentivizing it

3 Likes