legality of the PXDX review process ” as well as details of the numbers denied by individual Cigna MDs using PXDX .
Insurance company insiders have told these regulators that other large commercial health insurers use similar automated systems . So far , none has bragged about the warp speed denials , except for Cigna . However , Mike Kriedler , the insurance commissioner for Washington , said , “ I ’ m afraid it might be the tip of the iceberg . We darn well better start paying attention to it .”
Cigna has also claimed that it has “ passed the savings from these on to their insured clients ,” although Cigna did report a 24 % net increase in income for 2022 , reporting the total as $ 6.7 billion . Cigna did not provide to ProPublica how much it had saved from these denials , or how much of those savings had been passed on to clients .
Sadly , it was Dr . Alan Muney , a pediatrician turned executive for various insurance companies , who helped to develop PXDX over a decade ago . His team matched up tests and treatments for certain illnesses and simply kicked out everything not on the list , thus denying all value contributed by the physician who had actually talked to , examined and prescribed for the patient . ( We call that “ taking care of the patient .”)
The callousness of such wholesale denials of care – which is labelled denials of payment , but to the patient and doctor , that nearly aways equals denials of needed care – is typical of people who think only about money and not about the suffering of others .
The individual who is insured is a hurdle to be jumped , not a person needing help ; he is the loser , the one who is cleverly beaten by the insurance schemers . He ’ s already received the care : he can ’ t take that part back . What happens next , when something feels really wrong , and he delays tests for financial reasons ? Will a curable cancer turn to incurable ?
I do know that state and Congressional investigations are good things : but will any eventual penalty be effective , or will these companies simply use their billions in income to pay a fine , and change nothing ? There seems to be few consciences at work at these outfits , just accountants and bigwigs trying to one-up their competitors .
I don ’ t know if even ChatGPT could get past the PXDX . I do know that we need a Rep . Katie Porter type to hunt down the people who falsely promise coverage , then fail to provide it , hundreds of thousands of times . If only we could clone her .
References
1
ProPublica : 3 / 25 / 23 https :// www . propublica . org / article / cigna-pxdx-medical-health-insurance-rejection-claims - Patrick Rucker , Maya Miller , David Armstrong
2 https :// www . propublica . org / article / cigna-health-insurance-denials-pxdx-congress-investigation May 16 2023 ProPublica -Rucker , Miller , Armstrong
Dr . Barry is an internist and Associate Professor of Medicine ( Gratis Faculty ) at the University of Louisville School of Medicine , currently retired and mulling her next moves .
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