Health insurance really is just another grift.
Get rid of middlemen. Medicare for all
Cigna health giant accused of improperly rejecting thousands of patient claims using an algorithm
Submitted 1 year ago by Late2TheParty@lemmy.world to aboringdystopia@lemmy.world
Comments
BarterClub@sh.itjust.works 1 year ago
BassTurd@lemmy.world 1 year ago
Fuck Cigna. My employer switched to them a couple of years back. Every claim I’ve made I’ve had to follow up on because they suck so hard. I had a surgery and they tried to charge me more than my out of pocket max. I was submitting some out of network bills and got months I didn’t receive the statement of benefits. When I followed up, I was told they didn’t process them because out of network only pays out 60%. When I told them to go back and fix it, I ended up getting back over $700. Basic physicals have been declined and requires a phone call to correct. They are worthless. I’ve got coworkers with bills sent to collections because they don’t process them correctly. Just awful.
danciestlobster@lemmy.world 1 year ago
I wish I could say this was in any way surprising to me
Amazed@lemmy.world 1 year ago
Same.
You don’t make money by spending it… apparently. Which is why all health care should be a right not a luxury. Not profit driven.
Nepenthe@kbin.social 1 year ago
In a statement, Cigna Healthcare said the lawsuit “appears highly questionable and seems to be based entirely on a poorly reported article that skewed the facts.”
The company says the process is used to speed up payments to physicians for common, relatively inexpensive procedures through an industry-standard review process similar to those used by other insurers for years.
“Cigna uses technology to verify that the codes on some of the most common, low-cost procedures are submitted correctly based on our publicly available coverage policies, and this is done to help expedite physician reimbursement,” the statement said. “The review takes place after patients have received treatment, so it does not result in any denials of care. If codes are submitted incorrectly, we provide clear guidance on resubmission and how to appeal.”
Having intended to go into the coding/billing work that they're talking about, this is what I expected it to be and it was frustrating not knowing what the program was actually doing until the very end.
Private healthcare is mostly a money printing machine and you'd be horrified at the extortion that goes on beyond this, not only on the patient's side but for threat of the workers/hospital losing their license if they don't play along.
Yes, they will do anything they can think of to get out of paying and it's common for physicians to have to make appeals, whether it's over a procedure that's truly not necessary to life or legit convincing them the patient's cancer is maybe a problem. All of this is extremely intentional. We don't need it.
Having said that, also yes, they need to be checked over because this is official documentation for official payment. If the procedure doesn't match what was done or if the hospital is trying to sneakily double-bill someone, yes, they're going to kick it back to the doctor until they get it right.
That a lot of them have egos big enough to try to code it themselves while they're also doing their doctor jobs doesn't make this less difficult for either side.
Double-billing something, especially, happens enough that there's a whole word for it (bundling), and I encourage anyone worried about their bill to ask to have everything itemized in order to make sure they're not sneaking in some bullshit procedure they didn't even perform.
My personal opinion on this, I don't trust AI as far as I can throw it and idk whether it's at the point yet where it can reliably extrapolate from patient files the way a human can. Maybe??
But I'm not at all shocked and what it's resulted in is pretty normal. It's just that it happened faster. I'll be interested to know more about the details as this carries on.
Froyn@kbin.social 1 year ago
"Medically Necessary"
Just have the doc write it on all of their orders going through insurance.
Ballistic86@lemm.ee 1 year ago
Can someone describe a “proper” rejection for patient care?
Viking_Hippie@lemmy.world 1 year ago
“No, Mr Trump, you’re not getting the heart. Given your habits and overall health, it would be a waste of a perfectly good organ. You’re basically a tiny yeti mushroom dick on a barrel of toxic sludge”
Ok, maybe the last part wasn’t very “proper”, but it’s just as true as the rest 🤷
explodicle@local106.com 1 year ago
But even then, the people betting that you won’t get sick shouldn’t be deciding
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who won the bet, or
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who gets each heart.
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TWeaK@lemm.ee 1 year ago
Connecticut-based Cigna has 18 million U.S. members, including more than 2 million in California.
So 16 million customers are SOL against their shitty practices.
notacat@mander.xyz 1 year ago
I find it HIGHLY ironic that conservatives are anti-single payer because they “don’t want the government to say if they can have a procedure.” Instead they apparently prefer our current system of a for-profit company saying what medical procedures they can have. Health insurance overrides doctor decisions ALL THE TIME because approving procedures costs them money. Good doctors know the best ways to fudge the order to get things approved because that’s the only way to actually help their patients.
PC509@lemmy.world 1 year ago
Like gender affirming healthcare, women’s healthcare, etc… yea, government having a say is horrible unless they do what you want, then it’s ok.
Conservatives can’t even support their own ideals. What are they arguing about when they support the same shit they say they don’t…
HubertManne@kbin.social 1 year ago
pfft. insurance companies won't cover anything that it isn't mandated to.
Viking_Hippie@lemmy.world 1 year ago
But didn’t you know?
Person elected or hired by someone elected to take decisions on behalf of people taking decisions on behalf of people is satanic commie librul villainy!
Person not accountable to anyone but greedy shareholders doing so? The natural order of things!
/s