04/13/2023    

MEDICAL INSURANCE NEWS

Cigna Physicians Deny Claims en masse Without Reading Them

 

Cigna physicians deny large batches of claims without reviewing them first, a process that may save the company millions of dollars every year when members don't appeal, ProPublica reported March 25. According to the report, an internal claims system at Cigna allows medical directors to deny a claim without opening the patient's file. The report claims that Cigna physicians denied more than 300,000 claims over two months in 2022 through the system, which equated to 1.2 seconds of review per claim on average. "We literally click and submit," a former Cigna physician told ProPublica. "It takes all of 10 seconds to do 50 at a time."

 

Many states require medical directors to review patient files and coverage policies before denying claims for medical reasons. ProPublica alleges that Cigna has bypassed these steps by having a computer algorithm complete the review and then having physicians sign off on groups of denied claims.

 

Source: Jakob Emerson, Becker's Payer Issues [4/10/23] via Dr. Allen Jacobs