In a statement, Cigna Healthcare said the lawsuit “appears highly questionable and seems to be based entirely on a poorly reported article that skewed the facts.”
The company says the process is used to speed up payments to physicians for common, relatively inexpensive procedures through an industry-standard review process similar to those used by other insurers for years.
“Cigna uses technology to verify that the codes on some of the most common, low-cost procedures are submitted correctly based on our publicly available coverage policies, and this is done to help expedite physician reimbursement,” the statement said. “The review takes place after patients have received treatment, so it does not result in any denials of care. If codes are submitted incorrectly, we provide clear guidance on resubmission and how to appeal.”
Having intended to go into the coding/billing work that they're talking about, this is what I expected it to be and it was frustrating not knowing what the program was actually doing until the very end.
Private healthcare is a multi-billion dollar money printing machine and you'd be horrified at the extortion that goes on beyond this, not only on the patient's side but for threat of the workers/hospital losing their funding or license if they don't play along.
Health insurance will do anything they can humanly think of to get out of paying and it's common for physicians to have to make appeals, whether it's over a procedure that's truly not necessary to life or legit convincing them the patient's cancer is maybe still a problem even though they missed one chemo appointment. This is a thing that actually can happen in the US, I got in a heated argument with my instructor about it and more or less swore to go to jail.
All of this is extremely intentional. We don't need it. A lot of it isn't there to help the patient.
Having said that, yes, they would be checked over in any system because this is official documentation for official payment. If the listed code number doesn't perfectly match what procedure was done or if the hospital is trying to sneakily double-bill someone, yes, they're going to kick it back to the doctor until they get it right.
That a lot of them have egos big enough to try to code it themselves while they're also doing their doctor jobs doesn't make this less difficult for either side. Over/undercharging can be done by accident because shit's fiddly to the half centimeter.
Double-billing something, especially, happens enough that there's a whole word for it (bundling), and I encourage anyone worried about their bill to ask to have everything itemized and maybe explained in order to make sure they're not sneaking in some bullshit procedure they didn't even perform.
My personal opinion on this, I don't trust AI as far as I can throw it and idk whether it's at the point yet where it can reliably extrapolate from patient files the way a human can. Maybe??
But I'm not at all shocked that they would try and what it's resulted in is pretty normal. It's just that it happened faster. I'll be interested to know more about the details as this carries on.
