I am surprised commenters here did not read into the nuance:
> A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
Before grabbing the pitchforks, it is important to be sure if their policy is reasonable or not. Whose fault is it if doctors ask clients to perform expensive tests, because they can't be bothered to actually think and figure out what test would be the most optimal?
Now even if the doctors really overprescribe tests, I don't think the client should be responsible. Instead, the insurance should pay, but kick the doctor out of their network.
I don’t think we should trust the soundness of their algorithm. I’ve worked in the healthcare space before, and the perverse incentives involved should make everyone extremely skeptical of insurance companies’ motivations, procedures, and algorithms.
From the description it sounded like something trivial. E.g. given the diagnosis, there might be a cheaper known way to get to it. I am a layman, but for instance that could be ordering an MRI when an ultrasound would suffice.
It’s insane to trust an insurance company to make healthcare decisions. I was denied an MRI when I tore my hamstring off the bone, and so my doctor had zero info on what my treatment options should be. I went to physical therapy when I possibly should have had surgery.
I’d so much rather 10% of people overpay for unnecessary tests than the other 10% of people be denied potentially necessary care.
Not testing at all. You know what that leads to? Bad outcomes. I'm all for selection pressure toward more efficacious, less invasive, less dangerous tests. Writing an insurer a blank check to blanket deny millions of claims without checking or reading up though? Nah. That's profiteering.
You want to run that algo in parallel and dift through the claims that would change, individually weeding out the actual false positives? Kosher. Just YOLO'ing it on prod and trottingbit out in front of investors? Hell no.
> A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
Before grabbing the pitchforks, it is important to be sure if their policy is reasonable or not. Whose fault is it if doctors ask clients to perform expensive tests, because they can't be bothered to actually think and figure out what test would be the most optimal?
Now even if the doctors really overprescribe tests, I don't think the client should be responsible. Instead, the insurance should pay, but kick the doctor out of their network.