Breaking my 11-month-a-year profanity embargo, because ……… Fuck CIGNA.
I was one of their customers at one point, I am quite sincere when I say ……… Fuck CIGNA.
My regular reader(s) are probably that I have expressed dissatisfaction with the insurer in the past.
So I am amused that CIGNA is being sued for using software that allowed its examiners to deny thousands of claims per hour.
Here is hoping that they are hung out to dry:
Cigna, the healthcare and insurance giant, was hit with a lawsuit on Monday that alleges the company systematically rejects claims in a matter of seconds, thanks to an algorithmic system put in place to help automate the process—further raising questions about how technology could harm patients as more healthcare organizations look to embrace AI and other new tools.
………
The health insurer’s digital claims system, called PXDX, is an “improper scheme designed to systematically, wrongfully, and automatically deny its insureds medical payments owed to them under Cigna’s insurance policies,” the complaint alleges.
………
The suit follows a Propublica investigation in March that detailed Cigna’s software system for approving and denying claims in batches. The algorithm works by flagging discrepancies between a diagnosis and what Cigna considers “acceptable tests and procedures for those ailments,” according to the lawsuit.
Over two months last year, the company denied more than 300,000 claims, spending an average of 1.2 seconds on each claim, Propublica reported. While medical doctors signed off on the denials, the system didn’t require them to open patient medical records for the review. The complaint says that this violates a California competition law for unfair and fraudulent business acts. The suit also alleges the system violates the state’s insurance code for failing to adopt a “reasonable standard” for processing claims.
1.2 seconds in 1 hour, that is 3,000 denials per hour per agent.
I was not engaging in hyperbole above.
Somehow, I do not think that any jury will think that 3000 denials an hour an honest business practice.
Let me finish by saying, ……… Fuck CIGNA.
1 comments :
Denying claims that are known to be valid is standard practice. The same thing is done by the administrators of Flexible Spending Accounts and Health Reimbursement Accounts - Wells Fargo In particular comes to mind, but I'm sure that all of them do it.
They deny claims knowing that many patients simply can't cope with obtaining the paperwork to prove the validity of their claims. Particularly patients who are elderly or mentally compromised. Mind you, in the case of FSA/HRA claims, the information on those claims are forwarded to the fund managers directly from the medical provider or hospital. Apparently the reimbursement fund administrators believe that hospitals and doctors frequently provide non-medical services and accept an FSA/HRA card in payment.
Which is absolute bullshit, of course. They are simply rejecting claims in bulk because they know that a substantial portion of the wrongfully denied claims will end up being paid. That's how they make extra money.
I won't say that I want to see them frog-marched to jail, because I know that will never happen. If I'm going to imagine justice that we can never have, I'd like to see those bastards lined up against a wall and shot.
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