CIGNA Claim Denials and the Shame of For Profit Medicine

Posted by Dike Drummond MD

Healthcare in the USA has so much to be ashamed of:

  • Falling life expectancy
  • Abysmal maternal mortality rates
  • Massive overspending
All of those shortfalls are in comparison to all other 1st world countries.

Much of the blame for all of this rests with our multi-payor, fee-for-service, for-profit healthcare delivery system. 

Here is a SHINING EXAMPLE of the routine behavior of Cigna - one of the big pigs at the fee-for-service trough.

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How Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

[ The full article is here]

We all know preauthorization and claims denials are a constant and massive stressor on all patients, caregivers
and a proven and ubiquitous means to maximize profit by all payors.

Here's how Cigna gets the job done.


From the article:

"Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,” one former company doctor said."

The company has built a system that allows its doctors to instantly reject a claim on medical grounds without opening the patient file, leaving people with unexpected bills, according to corporate documents and interviews with former Cigna officials.

Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show.


We all suspected this, right? Here is the proverbial smoking gun.

Pretty sure the CFO sees this policy reflected in the spreadsheets and is very supportive of its effects on the bottom line.

This has to be criminal activity ... Yes?

Only Shame - and criminal charges - will stop this. 

The Profit Motive is a psychopath with no shame or empathy and Cigna would appear to be a sycophant.



I encourage you to take a look at the article and let us know "What do you think of this internal practice by Cigna?"

What steps should be taken to 
- punish Cigna?
- prevent this kind of behavior going forward?