A new investigation from ProPublica and The Capitol Forum sheds more light on how some corporate insurers delay and deny care.
According to ProPublica’s interviews with Dr. Debby Day, Cigna pressured its claims reviewers to engage in “click and close” decisions, which entailed copying and pasting pre-prepared denial language into claims forms after barely reading them. The speed with which patients’ claims were denied was tracked meticulously in a spreadsheet Cigna called “the productivity board.”
Per ProPublica and The Capitol Forum:
“Deny, deny, deny. That’s how you hit your numbers,” said Day, who worked for Cigna until the late spring of 2022. “If you take a breath or think about any of these cases, you’re going to fall behind.”
A previous ProPublica investigation found that Cigna’s doctors spent an average of just 1.2 seconds reviewing each claim, yielding more than 300,000 denials in a span of just two months. Rather than taking time to read and assess each case for medical necessity, Cigna’s doctors used an automated system to review and deny claims in bulk. As one former Cigna doctor said, “We literally click and submit. It takes all of 10 seconds to do 50 at a time.”
As ProPublica observes:
“Measuring the speed and output of employees is common in many industries, from fast food to package delivery, but the use of these kinds of metrics in health care is controversial because the stakes are so high. It’s one thing if a rushed server forgets the fries with your burger. It’s another entirely if the pressure to act fast leads to wrongful denials of payment for vital care.”
This isn’t the first time some corporate insurers have been caught using speedy and improper denials to pad their profits. According to multiple news reports, some corporate insurers routinely reject claims for necessary care, often with dubious justification, and rely on the low rate of appeals to minimize their payouts. In fact, last November UnitedHealth was exposed for using an AI model developed by its NaviHealth division to deny claims for elderly Medicare Advantage beneficiaries—an AI model which UnitedHealth knew had an error rate of 90% but put in charge of making crucial determinations on patients’ medical care anyway. That same year, UnitedHealth made a record $20.6 billion in profit.
It’s time to hold corporate insurers accountable for their predatory, profit-seeking practices. That includes these unreasonable, careless and arbitrary mass denials of patients’ care.
Read the full story from ProPublica and The Capitol Forum here.