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(CNN)   Cigna will try to improve the Chinese health care system, and if experience is any indicator by "improve" they mean send lots of inexplicable letters explaining why coverage is denied   (management.fortune.cnn.com) divider line 12
    More: Obvious, Cigna, Chinese, GE Capital, Chinese health care, Bernstein Research, life insurances, cosmic microwave background, Venice Film Festival  
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257 clicks; posted to Business » on 28 May 2013 at 9:08 AM (2 years ago)   |  Favorite    |   share:  Share on Twitter share via Email Share on Facebook   more»



12 Comments   (+0 »)
   
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2013-05-28 09:17:29 AM  
Great, my new job has our benefits plan through CIGNA. The mrs and I rarely get sick (knock on wood), but this could be a fun, rollercoaster ride with our benefits coverage.
 
2013-05-28 09:33:21 AM  
It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read
 
2013-05-28 09:41:44 AM  

Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read


CIGNA said they'll send you your PR flack check for that post as soon as you complete Form 54Q-TROLL and get the Fark Admin to code it as Procedure 22.4-SUCKUP.
 
2013-05-28 09:51:43 AM  

Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read


Really, just stfu.
 
2013-05-28 09:58:01 AM  

wejash: Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read

CIGNA said they'll send you your PR flack check for that post as soon as you complete Form 54Q-TROLL and get the Fark Admin to code it as Procedure 22.4-SUCKUP.


In the mean time, your physician has already received 3 denials for your office visit for hypertension because you haven't responded to Cigna's 3rd request for other insurance information (that you don't have, won't have, and have told them twice already that you don't have and won't have) or their 3 page questionnaire about your medical history.
 
2013-05-28 10:06:41 AM  

Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.


Know how I know you don't know what you're talking about...

I run a practice management company and we see every excuse in the book as to why a payer won't pay. I thought I had seen them all until last year we had a payer tell us they wouldn't pay on a course of radiation treatment because the radiation oncologist was credentialed with them as a radiation oncologist not as a family practice physician. (huh?) This was after they preauthorized the services under that doc's ID too. A screw up like that can sometimes take months to straighten out and the patient is left in limbo as they are ultimately responsible.

In the old days we would send a stack of 50+ claims in an envelope in alphabetical order. We would call a few weeks later to check status only to find that some from the top, middle, and bottom had made it into the system but that 15-20 would have randomly disappeared. Never could get an explanation from the payer as to how that was possible if they all came in the same envelope.

We had to start mailing appeals and medical records to Empire BC/BS return receipt requested if we wanted them to actually acknowledge receipt, otherwise we'd follow up on a denial and they'd tell us time was up and they didn't get the records. Funnily enough they received every single record we sent return receipt but rarely received the ones that were sent regular first class.

At least now with electronic claim submission we get an acknowledgement back on claims submitted so missing claims are almost zero now. We still, however, get plenty of moronic denial reasons that have nothing to do with actual plan design, just poorly functioning IT systems or drones. In the end the payer pays but not without a lot of work on our end to find and clear up the fark up.
 
2013-05-28 10:20:06 AM  

Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read


This is how to troll 9/10
 
2013-05-28 04:46:19 PM  
Their denial letters just say "Because Obamacare." now anyway.
 
2013-05-28 05:10:41 PM  
In China, if you don't pay your hospital bill, they won't give you the body.
 
2013-05-28 09:32:21 PM  

wejash: Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read

CIGNA said they'll send you your PR flack check for that post as soon as you complete Form 54Q-TROLL and get the Fark Admin to code it as Procedure 22.4-SUCKUP.


Not trolling. If you don't know your benefits, that's your goddamn fault.

EbolaNYC: Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read

Really, just stfu.


Eh, no. Thanks though. You must not be able to read a benefit booklet either.

flsprtsgod: wejash: Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read

CIGNA said they'll send you your PR flack check for that post as soon as you complete Form 54Q-TROLL and get the Fark Admin to code it as Procedure 22.4-SUCKUP.

In the mean time, your physician has already received 3 denials for your office visit for hypertension because you haven't responded to Cigna's 3rd request for other insurance information (that you don't have, won't have, and have told them twice already that you don't have and won't have) or their 3 page questionnaire about your medical history.


Do you know why a request for OHI is triggered? It sure as hell sounds like you don't. Perhaps if you knew, you could've resolved this the first goddamn time.

slykens1: Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

Know how I know you don't know what you're talking about...


No, I didn't know how you knew, so I started to read what you wrote, and then I read:

slykens1: Empire BC/BS


And I buckled over in laughter.

You're going to base your perception of the entire health insurance industry based on your interactions with Empire?

I'm so, so sorry for you. Everybody knows that THE most farked up Blue plan in America is Empire. If it takes you months to iron out a credentialing issue, or months to resolve a preauth, then you're either doing it wrong or talking to the wrong people. I can assure you, it's both.

Health insurance is easy provided you do it correctly. If you're sending in an appeal and it isn't sent certified, well, sucks to be you. If you're sending in med recs, were they requested by the carrier? If you're sending in unsolicited med recs, you're wasting your time, your money, and the carrier's time and money. There used to be nothing I enjoyed more than unsolicited medical records. On a rare occasion, we'd send a request as the provider sent them in, and that was ok. However, 98% of the time, records were being sent for bullshiat reasons. You didn't like the payment schedule? You're out of network, tough shiat. Go ahead, appeal it. You're going to lose because you're OUT OF NETWORK. Oh, you claim that this isn't W/C related even though you clearly indicated on your UB04 that it was? Well, no amount of medical records is going to make us change our mind until we get an inquiry back from the member. Why would be pay if someone else is responsible?

You submit claims. Do it correctly the first time. I used to see claim after claim after claim denied as a contract exclusion. What does that provider do? Change the diagnosis so it pays. That's farking fraud, and I saw it every.single.day.

This isn't to say that insurance providers are perfect, because they aren't. However, if you aren't willing to play by the rules we set forth in your provider agreement, then just stop accepting insurance and require your patients to direct bill insurance themselves. I can't help you if you can't help yourself, which is really what it sounds like.

/csb
 
2013-05-28 09:52:52 PM  

Your Average Witty Fark User: wejash: Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read

CIGNA said they'll send you your PR flack check for that post as soon as you complete Form 54Q-TROLL and get the Fark Admin to code it as Procedure 22.4-SUCKUP.

Not trolling. If you don't know your benefits, that's your goddamn fault.

EbolaNYC: Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read

Really, just stfu.

Eh, no. Thanks though. You must not be able to read a benefit booklet either.

flsprtsgod: wejash: Your Average Witty Fark User: It's your responsibility to understand your benefits, not the health insurance provider's responsibility to draw you a farking map. Don't piss and moan when you can't follow directions and your procedure is denied.

/never had a problem
//because I can read

CIGNA said they'll send you your PR flack check for that post as soon as you complete Form 54Q-TROLL and get the Fark Admin to code it as Procedure 22.4-SUCKUP.

In the mean time, your physician has already received 3 denials for your office visit for hypertension because you haven't responded to Cigna's 3rd request for other insurance information (that you don't have, won't have, and have told them twice already that you don't have and won't have) or their 3 page questionnaire about your medical history.

Do you know why a request for OHI is triggered? It sure as hell sounds like you don't. Perhaps if you knew, you could've resolved this the first goddamn time.

slykens1: Your Average Witty Fark User: It's your responsibility to understand your ben ...


I never said I didn't understand it you moron.

The way you people run things is inefficient and idiotic, that's a fact. Congratulations, you're a part of an industry people hate dealing with more than buying a car at a dealership.
 
2013-05-29 01:44:00 AM  

Your Average Witty Fark User: You submit claims. Do it correctly the first time. I used to see claim after claim after claim denied as a contract exclusion. What does that provider do? Change the diagnosis so it pays. That's farking fraud, and I saw it every.single.day.


So, you understand insurance claims and benefits because you can read... and you also work in the field.

Douchebag.

That'd be like me saying that I understand how to use Cicso routers because I can read.  Any idiot could be a network engineer!
 
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