P. Rucker and D. Armstrong
Propublica.org
Originally posted 29 APR 24
Here is an excerpt:
As ProPublica and The Capitol Forum reported last year, Cigna built a computer program that allowed its medical directors to deny certain claims in bulk. The insurer’s doctors spent an average of just 1.2 seconds on each of those cases. Cigna at the time said the review system was created to speed up approval of claims for certain routine screenings; the company later posted a rebuttal to the story. A congressional committee and the Department of Labor launched inquiries into this Cigna program. A spokesperson for Rep. Cathy McMorris Rodgers, the chair of the congressional committee, said Rodgers continues to monitor the situation after Cigna shared some details about its process. The Labor Department is still examining such practices.
One figure on Cigna’s January and February 2022 dashboards was like a productivity score; the news organizations found that this number reflects the pace at which a medical director clears cases.
Cigna said it was incorrect to call that figure on its dashboard a productivity score and said its “view on productivity is defined by a range of factors beyond elements included in a single spreadsheet.” In addition, the company told the news organizations, “The copy of the dashboard that you have is inaccurate and secondary calculations made using its contents may also be inaccurate.” The news organizations asked what was inaccurate, but the company wouldn’t elaborate.
Nevertheless, Cigna said that because the dashboard created “inadvertent confusion” the company was “reassessing its use.”
Here is my summary:
The article reports on Dr. Debby Day, who alleges that Cigna, her employer, pressured her to prioritize speed over thoroughness when reviewing patients' requests for healthcare coverage.
According to Day, managers emphasized meeting quotas and processing claims quickly, even if it meant superficially reviewing cases. Dr. Day said Cigna expected medical directors to review cases in as little as 4 minutes, which she felt was too rushed to properly evaluate them. The pressure to deny claims quickly was nicknamed "click and close" by some employees.
Day felt this practice compromised patient care and refused to expedite reviews at the expense of quality. The article suggests this may have led to threats of termination from Cigna.
