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

https://www.propublica.org/art...nce-rejection-claims

(ProPublica is on a roll....)

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ProPublica employees’ health insurance is provided by Cigna

ETA:

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Cigna emphasized that its system does not prevent a patient from receiving care — it only decides when the insurer won’t pay.

That's practically doublespeak right there.

We had Cigna up until this year and experienced this. LL#1 and I both had a broad set of blood tests done and out of all the tests Cigna denied payment for the Vitamin D test (the same one mentioned in the beginning of the article.) Turns out there are only a few diagnosis codes for which they will cover it. We both simply had the doctor resubmit with one of the diagnosis codes (which basically meant the doctor had to lie and say we had a history of Vitamin D deficiency....) and then Cigna paid. But if you aren't patient enough to comb through the fine print to find that list and then your doctor isn't willing to resubmit with one of those codes, I guess you'd be out of luck. It was an expensive test too - I think they were trying to bill us $500+ each. Health insurers suck....all of them.

We have united healthcare now and I'm not sure they are any better.......I've been fighting with them to pay a claim from LL#1's annual well visit (which should be 100% covered) for months now. Every time my mom goes on a rant about how awful universal health care is and how she just heard from her cousin's friend's old roommate that they had to wait 2 years to see a doctor in Canada, I just want to throw stuff like this back in her face. It's not like things are wonderful here either.

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“It’s not good medicine. It’s not caring for patients. You end up asking yourself: Why would they do this if their ultimate goal is to care for the patient?”

The ultimate goal of insurance is to make money, or in the case of nonprofit health insurance, to minimize costs, at least in some cases.

As you might imagine, I've had enormous medical charges associated with my ongoing knee surgery complications. There have been plenty of denials, some of which were appealed or re-coded by the providers and ultimately paid and others which simply were dismissed. There are appeal processes in place that ultimately can generate an independent review outside the insurer's control.

To my mind, the more dangerous situation is when procedures require preapproval which, if denied, can result in denial or delay of treatment. It might not matter sometimes, but if time is at all important, it could be life-threatening.

The entire medical system in this country is so convoluted in its organization and management that no one can fully understand it or realistically see how to improve it or make it less expensive without generating new negative results.

Big Al

The Cigna lies and cheatings, actually denying claims without even reviewing them! Mere seconds flipping through individual submissions! How DARE they!?!

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Originally posted by big al:

...As you might imagine, I've had enormous medical charges associated with my ongoing knee surgery complications. There have been plenty of denials, some of which were appealed or re-coded by the providers and ultimately paid and others which simply were dismissed. There are appeal processes in place that ultimately can generate an independent review outside the insurer's control.

To my mind, the more dangerous situation is when procedures require preapproval which, if denied, can result in denial or delay of treatment. It might not matter sometimes, but if time is at all important, it could be life-threatening...

Big Al

So sorry to hear how all this deliberate insurance tangle has affected you, Big Al. As if you hadn't already gone through enough hell with your knee nightmares!