Right After the Marketing Division of the Sirius Cybernetics Corporation*

The folks at Cigna (F$#@ Cigna) have have established a brave new system of claims reviews, where they have setup a system that rejects claims without any human being have reviewed the claims.

At the medical insurer, reviewers spent an average of 1.2 seconds per review.

I have had the misfortune of being a Cigna customer for some of my employer covered plans, and I am rally surprised that someone is not vandalizing their offices on a weekly basis:

When a stubborn pain in Nick van Terheyden’s bones would not subside, his doctor had a hunch what was wrong.

Without enough vitamin D in the blood, the body will pull that vital nutrient from the bones. Left untreated, a vitamin D deficiency can lead to osteoporosis.

A blood test in the fall of 2021 confirmed the doctor’s diagnosis, and van Terheyden expected his company’s insurance plan, managed by Cigna, to cover the cost of the bloodwork. Instead, Cigna sent van Terheyden a letter explaining that it would not pay for the $350 test because it was not “medically necessary.”

The letter was signed by one of Cigna’s medical directors, a doctor employed by the company to review insurance claims.

………

The vague wording made van Terheyden suspect that Dr. Cheryl Dopke, the medical director who signed it, had not taken much care with his case.

Van Terheyden was right to be suspicious. His claim was just one of roughly 60,000 that Dopke denied in a single month last year, according to internal Cigna records reviewed by ProPublica and The Capitol Forum.

(emphasis mine)

Running the math, 176 hours and 60,000 denials is 10.6 seconds per "Review".

Why this is not a violation of medical ethics by Cigna's trained squirrels?

………

Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.

But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. 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.

“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”

They need to start suspending these doctors' medical licenses, and maybe frog march some executives out of the corporate offices in handcuffs.

^*Hitchhiker's Guide to the Galaxy, remember?
“The Encyclopedia Galactica defines a robot as a mechanical apparatus designed to do the work of a man. The marketing division of the Sirius Cybernetics Corporation defines a robot as "Your Plastic Pal Who's Fun to Be With. The Hitchhiker's Guide to the Galaxy defines the marketing devision of the Sirius Cybernetic Corporation as "a bunch of mindless jerks who'll be the first against the wall when the revolution comes.”