This came out yesterday. Even if other companies are doing similar (I don't know myself), this is not a good look. And continuing to press hard on the outsourcing and AI is probably not the way to go to improve matters..
https://www.propublica.org/article/cigna-medical-director-doctor-patient-preapproval-denials-insurance
I have been in the clinical end of this with UM review for years. I wish I had a way to contact this woman and thank her for giving this issue a voice. I can assure you that every nurse and doctor feels this to their very core. Quality at Cigna is dead because they cannot put it in the bank.
The overwhelming majority of denied claims are never revisited.
Well, I don’t work in claims, appeals or denials, but this all seems fairly accurate to me. The pressure regarding metrics and productivity really ramped up about the time the article noted.
The funny thing is - the rep from Cigna in the article stated that it would be quicker to approve the claim, and used that as justification that Day’s assertions are nonsense. The representative ignored the fact there is financial incentive to deny the claim, even if it is quicker to approve it. I hate how Cigna thinks everyone is d-mb.
This lady worked here for a significant amount of time. I think there’s a lot of value and credibility in that. For us who have been here for a decade plus, this place seems like it’s from a totally different universe.
Cigna won’t care how it looks unless it results in lost revenue or fines. It is all about the money, and the company would put us all into slavery if they could get away with it. Only shareholders getting a return matters, the rest is immaterial.