Insurer Routinely Rejects Claims without Opening Patient Files

Handwriting: Where's my health Insurance

According to a Propublica, non-profit newsroom, article by Patrick Rucker, Maya Miller and David Armstrong, 3.25.23, Cigna health insurance doctors are routinely rejecting patients’ claims for medical care, without ever opening a patient’s file. With a click of a button, patients’ claims are being deemed as not “medically necessary.” The article states that documents for these claims show that Cigna doctors denied over 300,000 requests over a two month period.

Authors interviewed former Cigna employed doctors and reported that it is common practice where a Cigna algorithm automatically identifies mismatches between diagnoses and what Cigna considers medically necessary tests and procedures for those diagnoses. These claims are then signed off on in batches by doctors employed by Cigna. This practice leaves hundreds of thousands of patients with unexpected medical bills, and saves the insurance company millions of dollars. Authors chronicle the claim dispute of a single patient that chose to appeal the system.

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