It amazes me that a company that is made of non-medical professionals are allowed to make decisions that directly affect people's health that undermine actual medical professionals' decisions. Insurance companies are literally playing doctor without a license.
I literally said this to my sons speech therapist! How can they tell me what my son doesn’t need when they don’t even know him 🥺 I hate it. We appeal but still. It frustrates me to no end.
This is how I feel about our legislators signing away our reproductive rights too. Most voters aren't medical professionals, and over half of our elected officials never even need to worry about giving birth. Although, what insurance companies have that our legislators don't: paid doctors to approve these claims. Giving them one button to deny hundreds at a time is beyond negligent.
Sure, you say this, til Tucker Carlson wants you to pay for his infrared teste-therapy visits and people start getting blepharoplasties to take their eyebrows up 3 inches on your dime. FR though an MRI should be free with insurance once a year tho. It's insane that they throw imaging so many roadblocks. It's a gd diagnostic tool
CIGNA is definitely one of the worst in terms of automatic denials, but almost all the insurance companies are guilty of rejecting charges for things like anesthesia or radiology services that might happen during surgery, because often a hospital will have a person on staff (or a contract/locum tenens worker) who doesn't take a given patient's insurance, and they don't check ahead of time to make sure that everyone on the case is a participating provider. Sometimes, even if the patient calls ahead of the procedure to the insurance company, and confirms that the hospital and the surgeon are "in network" for their policy, they don't know which anesthesiologist is going to be working the case at the time that they get the approval. And quite frankly, how many patients even think to ask about such things? And it is much much worse for emergency services, when there's no possible way to call ahead of time to confirm coverage. One of the many reasons that we need universal healthcare
Hearing "not medically necessary" is so triggering to me now. I have been in pain for years and so many things have been denied on the grounds that it was "not medically necessary." It's horrifying and makes me miserable.
@@MikePerreman Oh you know those doctors. Suggesting things to keep your healthy and pain free. silly doctors! Thinking being healthy and pain free is medical necessity.
Bro you are falling for this world matrix, when will we all just stop following these fools that rule the world from the shadows like a bunch of cowards, we out number three by a lot when will people take back the power we should have 😢
My bio Dad had stage 4 COPD. He was on a wait list to get a life saving treatment. It was finally his turn, and his insurance denied it twice. He passed away 3 weeks ago. It’s heartbreaking when these companies care more about making billions than human life.
I know this is a really tough time for you but you should sue them. If nobody holds them accountable they're gonna keep doing it. They're gonna keep killing people's family members.
@@taylorbug9 it’s true, I know I have had issues in the past because of insurance. Thankfully for me, I was able to get Medicaid and thats made things better, hopefully I don’t lose my insurance because of the policy expiration, I enrolled on Medicaid during the pandemic…. Makes zero sense that we don’t just provide everyone healthcare like almost every other country.
@@taylorbug9 Sue and appeal to the supreme court that this is violating the entitlement to life under "Life, liberty and the pursuit of happiness." the court won't by it but the more people who do this the more trouble we cause for companies like cigna.
Healthcare execs need to go to prison for this. Imagine the amount of people who had to go through excruciating pain or even died because their claims were denied and they weren't able to access the care they needed. Class war must be waged against the billionaires and evil corporate interests that have their foot on the necks of working class people.
It's too late now. So much money is being profited from health care that to stop it now would send our economy into a tail spin. Nearly 18% of the US GDP is the Healthcare system
This hurts my heart so much. My previous employer changed insurance companies to Cigna at the start of the year and they refused to cover my medicine that was already approved and paid for my the previous carrier. They wanted me to start paying $137 per pill out of pocket, which was just way out of reach for me. I got so sick of fighting them I eventually ended up changing jobs to get better insurance coverage. Now I am questioning if my case was ever even reviewed by a real person.
I hope there's an actual, European-style lawsuit for this. Not an American lawsuit, where they get hit with a fine that's about 2% of the profits they got from the crime. I'm talking about completely liquidating the company, putting everyone on the board in jail, and redistributing all the money gained to the people who were affected. It isn't going to happen. But I really wish it would.
@@dianaw4072this is exactly why I don't have health insurance. For a family of three, I'd be paying $800 a month, and our medical bills only total about $300 a month. Do they seriously think everyone just has an extra $500 every month laying around?
I work in medical billing. Regarding the denials due to "medical necessity", 9/10 it is NOT YOUR DOCTOR forgetting to leave something out on your clinical documentation to indicate the need for what you had done. It is the insurance. I've been noticing insurance companies convincing patients to come back to us after we advise them to file an appeal with the insurance. They don't want you to file that appeal. Force them to let you file it!! They cannot deny you that right. Many people come back and yell at us saying the doctor needs to submit it as medically necessary but again, 9/10 it's not that anything's missing it's that your insurance is telling us they disagree with your doctor's professional diagnosis. The system is fucked beyond all reprieve.
My favorite line from patients is "the insurance company said you coded it wrong." OH really? How should I have coded this claim that I have coded the same way with no issue for the past 200 claims? What's that? We at the insurance company can't tell you how to bill? But you can still say we billed it wrong.
Exactly! I work in the same field and the insurance tells the patient that we never submitted the "additional information" that they requested when we always do and the patient is left feeling like we are lying and not doing our job. I mean seriously, it is in our interest to get approved for a procedure.
@Osan Naso omg spot on! It's so triggering! And then you speak the claims department and they can't do anything, they don't understand anything and can Give you no way of how to fix their issue
@@osannaso5613 My insurance told me my mammogram was coded wrong. I called the office and they were like... no honey I promise it's coded correctly. Who denies a mammogram??? Nobody out here getting their boobs crushed for $500 for fun. I didn't know the coding thing was a lie they tell for rejections often.
I hate insurance..they denied my claim that my child's wellvisit was covered claiming my doctors office wasn't in-network even though their certificate says otherwise. They suck so much.
Cigna is not the only insurance company doing this. I worked as a medical receptionist for years and I stopped working in this field because of how difficult and demanding it was to deal with insurance companies on a day to day basis. I was calling on behalf of the doctors prescribing the medication, treatment or testing and it was still next to impossible. It was clear that the job was to find ANY reason to deny coverage to the patient. What I learned was that your doctor doesn’t really decide what treatment you receive the insurance companies do. Don’t even get me started on monthly pre-authorization for medications that keep you alive or that cause less side affects!!
Same. I managed an insurance department for 6 years before I finally broke and left. It’s mentally exhausting to come home every day after dealing with these companies
@@xena2shoes 100%! I used to come home and have to basically sit in silence for an hour just to get my brain to stop! ❤️ thank you for the comment as well!! I really struggled with not beating myself up for feeling like the job wasn’t worth my mental health anymore.
This! I literally tell people I get to yell at insurance companies for a living. It makes my day, week, and sometimes month when I finally get them to pay what they actually owe!
It took me just over 5 months of constant pestering, appeals and calls to the customer support line to FINALLY get a near $10,000 bill to go through my insurance and have it properly covered. I got a "nice" letter from my insurance basically saying their decision was final, it was reviewed and I'd have to owe a bunch of money that I just KNEW I shouldn't have needed to pay. I made so many phone calls on lunch breaks while at work and during my off days for months. So many written appeals I lost count. I was at my end. I was almost done fighting and almost gave up. I was days away from giving up when I finally got a notification that they were covering a huge portion of my medical bills. I remember getting the email notification that a new statement had arrived. I assumed it was another denial and a new bill. To my surprise it wasn't. The relief I felt is indescribable. I wanted to cry both from the financial relief, but also because... Nobody should ever have to go through that. At ALL. So when I hear these kind of medical stories, I know I am not alone but that others had it worse than I did. It's extremely sad and disheartening that this stuff occurs. And to think how many people either just pay up because "well they know best so they must be right" or because they'd rather pay than fight it. It's sad this happens. Sad is a huge ass understatement.
Cigna denied my meds 6 years ago, preventing me from getting treatment for my newly diagnosed ms (the other treatments were either dangerous for my other conditions or unnecessarily painful for me). We fought it for 6 months and they held firm I should try the more dangerous and less effective treatments first. I ended up having to get into a research study to even be able to afford my meds.
I'm lucky to have an oncology team that stands up to my insurance company. My husband gets insurance payments taken out of his paychecks, so it's not even as if insurance comes free with a job. You basically have to have a job to get into a group, and we still gotta pay out. At least isn't not as expensive as private insurance outside an employer's group. That said, even though we pay for it, the insurance co tried to increase my Letrozole dosage just for them to save like 50 cents. It's a cheap cancer drug, but nobody wants more of those side effects than absolutely necessary.
Thats incredibly heart-wrenching that in order to get proper treatment, you had to make yourself into a research subject. Im glad you got the treatment though
Phil, thanks for covering the Cigna issue. I am a clinician practicing in chicago and have had nightmares with them for years. Currently treating a patient with Cigna who had an awful stroke. We are literally doing rehabilitation to get her to walk, run, and be active again. She is 29 years old. Cigna has upheld that any care is "not medically nessecary" for the past 8 months. Not medically nessecary to return to normal life following a medical event. The system is a joke. I wish i could say this was an isolated incident for us. Just the most recent status quo.
I won’t go into the long, horrible story but Cigna played a huge part in why I quit my last job and was almost evicted last year. I am unbelievably unsurprised and still livid. This is THEFT AND TORTURE
This is exactly why I believe that heads of corporations should be criminally charged for perpetuating systems like this in their companies. The only way ceos are going to change is by threatening them with prison time.
I'm a hospital social worker who has to wrestle with Medicare Advantage plans everyday. I promise this is just the tip of the iceburg. So impressed this is getting attention from Phil. The system is so broken, and most people don't figure it out until its too late.
I have had MA plans for years as a person under 65 on Medicare. MA was the only option available to me in the state I live in (as in most states). I absolutely hate --- hate--- MA. It nickels and dimes you to death. I had a ruptured disc last fall and the surgeon told me he'd have to try me on pain meds, wait at least two weeks and have me do PT. (at least one or two sessions) before insurance would pay for an MRI. I did all that -- in pain--to get an MRI that showed enough damage to warrant surgery.
I once actually went through the numbers behind my retirement plan and even if I got to live up to 100, I'd have more by depositing that money and later just directly withdraw.
As a Brit, I feel so lucky that I never have to deal with Health Insurance. The UK kinda sucks and the NHS isn't perfect but I never want to go through what people in the USA do to get treatment.
I hope you guys in the UK can prevent those who seem hell-bent on destroying the NHS from succeeding. As an American, it's hard to not look at some in your Government and see them as anything but paid advocates of moving you to the American system for the sake of the greedy who want to squeeze profits out of you like they do here - while still underpaying the doctors and nurses that are doing the actual work.
Its crazy seeing this because I used to work for them. One time I was helping a health care worker try to get a claim approved for a hospital visit for an infant who died during childbirth. The reason the baby wasnt covered is because you have to claim them after theyre born but they were dead so they couldnt do that. They were fighting for this appeal for over a year after the babys death, they owed almost a 200k without approval. It was fucked up
@@breezyncj Depends on the company/state, but most of the time, they'll send it to debt collectors who can put liens against you, your wages, and your property if you own a car or house. Over the death of your child, you could have your house taken from you by the hospital. Its that fucked up.
Stories like this make it difficult to avoid advocating for serious physical harm against these people. If it was any other point in history, these people would be hung in public, and rightfully so.
@@breezyncj College loans and medical debt is treated differently by the government. It doesn't go away if you declare bankruptcy, and people can just show up and take your stuff. Also, they can put a lien on things you own. For anyone who doesn't know, that's the government saying you can't sell your house or your car unless you pay your bills first. It's super messed up.
THANK YOU FOR THIS. ALL INSURANCE COMPANIES DO THIS. they will deny for things that aren’t even real. As someone who works in medical billing it’s so hard to get ppl to understand it’s not the hospital or the biller it’s the insurance companies refusing to payout
A friend of mine had his Cochlear implant surgery denied by insurance a couple years ago because his first doctor said it wouldn't help him, but his new one said there was no reason it wouldn't. He got it on appeal, and has since gotten both sides done. He loves music, enjoys listening to his cats purr, and hates his neighbor's motorcycle.
The fear of having a large medical bill nearly killed me in 2017. I came back from a Disney vacation and suddenly got very very sick. I thought it was the flu or food poisoning so I figured I had to just ride it out. My boyfriend (now husband) kept asking if I wanted to go to the ER since I was so sick and couldn’t even hold down water. I kept telling him no because it would be super expensive (even with health insurance) to just get fluids and anti nausea meds and be sent home and then get a 1000 medical bill. After 5 days with zero improvement literally carried me to the car and took me to the ER. Turns out I had colitis and had severe dehydration to the point of nearly having a stroke (my blood pressure was SKY HIGH), I had a 103.9 fever, and my organs had begun to shut down due to the dehydration. I had also severe damage to my throat from throwing up so much and all the acid and bile in my throat. The triage nurse went sheet white when he saw my BP and immediately went to get the doc. Ended up in the ICU for three days and spent months recovering from the damage. Had I got to the ER right away the colitis would have been cleared up in about a week or so with meds (I didn’t know what I had was colitis until they told me and I had never had it before so I thought it was the flu) But I was so worried about such a big bill even with my insurance I kept telling my husband no I didn’t want to go to the hospital. Doc told me had I gone to bed that night I wouldn’t have woken up due to a massive stroke. My fever thinned my blood just long enough to get me to the ER. Had I survived the stroke it would have led to severe long lasting brain damage. Insurance people don’t care about their customers. They just want their money and because of it, they basically almost killed me. Even with insurance my hospital stay was nearly 3K. I absolutely HATE insurance and our stupid healthcare system. Unfortunately, it’s the only one we have at the moment and due to on going medical issues I am forced to use it. We truly need massive healthcare reform but I am not holding my breath. Both sides of the political aisle are too greedy and corrupt to ever make any real meaningful effort to change our current system. They would loose too much money.
My gosh that is a terrifying story. I'm so sorry you had to go through that. I'm glad your husband was there, he sounds like a keeper. It's stories like these that make me feel almost guilty about living in a country with public health services, although they are far from perfect, believe me. Sending you love and hugs 🇦🇺
I almost lost my husband from delaying because of poor health insurance. He had a broken tooth and had to have a root canal back in March 2019. He had to pay $950 out of pocket for the root canal and was prescribed 800 mg of Ibuprofen twice a day. Little did we know that was the start of our lives changing forever. By May 2019 my husband was having some heart blood pressure issues and was taken high blood pressure medication small dose once a day and by June 18th he developed extreme hypertension in his lower exterminates and difficultly catching his breath. He setup an appointment to have an EKG done with his regular doctor later in the week but he knew something wasn’t right so on Monday afternoon he wanted me to take him to the ER after I got back from work has he felt he was going to pass out but knew he might not wake up from it. He was a retired EMS/firefighter so he knew what he was feeling wasn’t right. We even discussed how much this is going to set us back financially and was worried we could lose our house to medical debt. When we got to the ER his blood pressure bottom out and they had to give him medications to bring it back up. They did some tests and an ultrasound on his heart and we discovered he was in full blow congestive heart failure and had cardiomyopathy with an enlarge left chamber that was not pumping correctly causing him to have the hypertension and breathing problems. They decided to keep him overnight in the ICU and possibly transfer him to a major hospital but by that evening he went into cardiac shock and had to have a ventilator put in to stabilize him. He then was life star to a major hospital to have the ECMO put on him and 5 days later on June 25th he had a heart transplant! He was only 46 years old at the time, never smoked and haven’t drink in years. He was a work horse as a master electrician for 25 years and worked around the farm too. We were very very lucky to live in a blue state that had Medicaid for it’s residents HOWEVER we didn’t qualify at the time because we were just above their income cap and being self employed had little to no options for insurance. It took my husband to become permanently disabled to get the insurance coverage he needed. They fortunately back dated it to the beginning of the month when he had the heart transplant so everything from the moment he walked into the door of ER was covered but let me tell you the bills I saw from the experience shocked us. This whole experience cost over a million in 10 days time and that’s not including his life long medications costing thousands a month, tests and monitoring he faces. Again living in a blue state that helps the residents he has to stay here for the rest of his life in the network to survive. We both know that if he had this happened to him in a red state especially one that bans the Affordable Care Act he wouldn’t be live or forever in debt. This all could have been avoided if he had better dental care and better insurance coverage that would have brought him in sooner and possibly avoid the heart transplant. He’s doing Ok but basically he forever changed but glad he is still here with us especially for our young daughter.
To be fair the Republicans ideology is specifically to privatize, sure Democrats aren't great and they're corrupt as fuck, but nothing will change for the better under Republicans
Oof! That's awful, I'm so sorry you had to go through all that... I physically cannot even conceive of what that must be like to live somewhere that normalizes and allows for things like this, where people become accustomed to avoiding medical treatment at all costs, even WITH insurance, due to fear of the bills. I live in Canada and in Ontario no less, where our Premier (dude in charge of the province) is trying to actively change our system to a paid one like yours. It's absolutely disgusting and I pray that it never comes to pass and that we all, as a society, continue to vote against such things.... Unfortunately, there are a lot of VERY STUPID privileged people here who only care that the taxes are high because of the free healthcare and want "their money back in the pocket". Absolute nonsense, considering they'll just end up paying it all out AND THEN SOME the next time they get sick. People here don't even consider NOT going, like you did. If we sneeze wrong, many of us will go in (or did pre-pandemic anyways), and most of us are reminded by stories like this that our system, flaws and all, is worth fighting tooth and nail for. My sister will be moving to the USA soon to marry her beau. I'm scared for her, with all of her health problems... She already struggles to keep her health in order here, where she has access to many services and professionals free. What will she do there? Especially now her illnesses have caused her to have to stop working for a time. I mean, what good is having all the best doctors on this continent, if so few can actually afford it and most are avoiding going in until it's REQUIRED due to wanting to avoid bills? I hope and pray things will improve for you all over there, and that one day you will all have basic health care needs met without fear of financial ruin as a result.
Every single working class and middle class person in America unfortunately knows someone in your position. Please do not take that as a slight against your horrible and despicable situation that you suffered through. My job pays almost 20,000.00 dollars a year, including my own payroll contributions and yet anyone who has a serious medical situation almost always has to choose between treatment and bankruptcy. The American dream is dead and never coming back, thanks to the absolute greed that is predatory capitalism. I am not advocating for Communism, but when you look at our near peer Western Democracies, we are literally the only country that is dealing with this issue. Its a travesty that I hope younger generations are extremely aware of and maybe in my lifetime will change. Your story rips at every fabric of decency in my body and I hope that everyone on both sides realizes how f**ked over we are by both sides of Congress being bought by big pharma and the insurance industry.
@@rey_8834 Pointing out that the system is working as intended. This is not a democracy and the ruling class gives zero fucks how cruel and miserable things are for us.
As a physical therapist, this is no surprise to me. Cigna and others deny for no reason and they will not tell us why. Leaving the bill to the patient. The patient is mad at us but it’s the insurance who is at fault.
Just over 3 years ago I had an allergic reaction to an antibiotic and it basically put me into immediate liver failure. In and out if the hospital for months, never ending tests etc. I was actively dying. I needed a live saving transplant but couldn't even be put on the transplant list until I had Medicare because I didn't have insurance. I called them almost daily begging them to look at my case and every time they'd say "we have up to 3 months to approve or deny you". I didn't even have 3 months left to LIVE and i was only 27 years old. If MULTIPLE doctors are telling me and insurance I absolutely need this or I'm going to die that should be the end of it. I should immediately be getting help. Not sitting and waiting on a fucking insurance company to decide to approve or even deny me if they feel like it. I ended up reaching out to my governor begging for help because I was just stuck and had no other option. It was that or just wait and keep slowly dying. Thankfully, he read my case and within 2 days I was in the top three on the transplant list because my case was that bad. About two weeks later I got my transplant. I got incredibly lucky. With absolutely no fucking help to the insurance. And I was 27 years old. Think about all the people my age and younger that are dying everyday just because insurance says "meh" and doesn't give the slightest fuck.
I used to work at a medical office for Sleep Apnea. Which can be deadly. And Cigna almost always refused to pay for it (a CPAP or BIPAP) even when their conditions were severe. So my advice for those patients was so switch coverage. But then they would have to pay for a sleep study all over again for the new coverage and that isn’t always covered fully. It’s such a broken and confusing system.
@@wendylea1983 that’s super common sadly. The home studies are convenient but not as accurate. You can have your doctor write that up. You can also submit your data from the chip in your machine as evidence of treatment and improvement because it should track how many apneas you have in a night. Your doctor should be able to access and print the report for you.
I hate insurance rules about sleep studies. When conducted according to the (very restrictive) rules, they are really only good at diagnosing sleep apnea or restless leg syndrome, and any of the many other sleep disorders can be missed in that one single miserable night. And then the insurance companies will use the “failed” sleep study to deny coverage for treatment. I have a circadian rhythm disorder and “failed” my sleep study and had to pay out of pocket for years, until a doctor convinced the insurance to accept actigraphy instead. Even now I can’t get treatment for the hypersomnia they suspect I also have without a sleep study.
I have long thought of insurance as little more than a scam. I do not understand why they are allowed to reject something a professional calls for or deems required.
They make literal billions by stealing money from citizens while fucking them over and not covering them for medically necessary tests, procedures, or diagnoses - the ONE thing they're supposed to do. With this money, they can line the pockets of politicians to increase their margins even further, or at the least keep the scam going for as long as possible.
I never got why there is anything other than universal healthcare. like end of the day we're all paying regardless, only with privatized healthcare there's a ton of useless middlemen like insurance companies taking most of the money.....
@@zwenkwiel816 Yea that part is what they try to hide from people who already have insurance they're okay or happy with. The fact that universal or not, they're still kind of paying for other people. When the insurance company doesn't have as much young people on it as it wants, it ups prices, when it's having to pay out for a bit more sick people than it likes, up goes the prices. When they just want to have a better quarter, time to pump those price numbers!
Insurance as a whole in this country is a complete and utter mess. My mother is an audiologist and just hearing her experiences with filing claims is enough to make me feel stressed. She’s been saying for years, they’re practicing medicine without a license.
I work in a hospital billing department and talking to insurance companies is like talking to a wall. I can't count the number of bills we've had to appeal and send back to insurance in the last week alone. What they deny is astounding!
My last job used Cigna to approve medical time off cases. It was an absolute nightmare to get anything approved and like you said, appealing anything was such an insane bunch of hoops to jump through. They weren't approving anything with long covid at all and a bunch of people lost their jobs because of it.
This doesn’t surprise me, I had this exact same issue with CIGNA. My doctor would have to battle them weekly to continue providing me with the treatment I needed to get better, because they didn’t think I was “sick enough” to be treated yet. I am 6’ tall, and should weight between 140 and 150 pounds, I was 100 pounds and my *kidneys* were shutting down, but yet CIGNA kept saying that I wasn’t sick enough to be treated…
Happened to me years ago! Took me forever to get into treatment. I was about the same size as you mentioned and they said I wasnt “sick enough “ either.
As someone who grew up in Texas and didn't have insurance for most of my life because my parents were in that medicare gap, this is very concerning. I was only able to get insurance in the last few years because my job provided it. It makes me wish we could switch over to a universal type of healthcare. A company shouldn't have more power over personalized health treatments than you and your doctor, its crazy.
This is something that's very hard to explain to people here in Canada. Yes, you can have insurance, but there's no way to know if it will actually pay out. It doesn't work at all like the extended benefits in Canada.
I can't imagine paying 350$ for a blood test?! and my insurance not covering it? I go for routine blood tests every year for free, and if I had to pay for those as a broke student, would be insane.
Blood tests are free. So are x-rays for broken arms as well as the cast and treatment. Canada's system is far from perfect, nor the best. But I just got home from 2 days in the ER and many tests later, I'm going to be just fine from a severe reaction to antibiotics. It cost me the price of parking.
OMG can you do more on this and expose them completely???? My roommate just has the most horrendous experience with Cigna, waiting 6+ months to get something approved (which only made her current state worse), and the only reason she got it approved was bec by some miracle we found a specialist who knew a back channel but like... otherwise ???
Devil’s advocate here: it’s not that theyre “evil,” as if it’s something inherent to then, it’s that the system they live in encourages and rewards greed and abuse
America is a business, it's pretty clear it does not care for human life. All of the international community are terrifying careful to try not let this happen at home, America is still the wild west, except the robberies are white collar, and legal. Goodluck, you are going to need it.
Everyone with morals leaves these kinds of jobs so there's a lot of turnover until an actual sociopath ends up in the role. So weirdly enough, these kinds of jobs are very good at finding extremely morally bankrupt people given enough time. As long as healthcare is run for profit, this end result is 100% guaranteed. So take some comfort in knowing that it's not that everyone is evil, it's just that the system is incredibly good at finding the most evil people and putting them in these positions. Good people are not outnumbered, but rather rigged against.
I remember working at a pharmacy and UnitedHealthcare was the worst offender of this. Routine psych meds would always be denied because a diagnosis code had to be used and only a specific med would be covered under a group. Nevermind that the med was available for decades and the other med covered doesn't work for the patient. We had a doctor call the insurance and he had to plead to them to give the ICD-10 number that worked and what could be prescribed. Then the issue may happen every month the patient needs a refill. Medicare also has a similar issue with ICD codes being needed for medication filled at the pharmacy.
100%! Cigna, I'm not surprised about at all. But I've found in my own experience billing for doctors that UHC tends to be far worse. They won't tell you anything, expect you to jump through hoops for payments that are minimal at best, and if you're not participating with them? Forget it. You're not getting a dime if you're not ready to fight.
I had UHC start denying my medication because my doctor didn't order the right amount that they liked. Then hey told me I could get my meds approved if I went to a pharmacy they partner with except that pharmacy chain doesn't exist in my town. So my meds are not medically necessary unless I go to a specific store to get them. I have to use coupons to get it now.
Wow. That’s eye opening. I used to work for a psychiatrist, in the late 90s, and I have to say at that time UHC was the worse insurance we worked with for the pretty much all the documentation we had to do for prescriptions. Also they required every three month primary care referrals, when we only saw our patients every three months… so unnecessary. We had to remind our UHC patients constantly to to not come unless they had their referral in their hand. Every other insurance company had annual referrals. I can’t imagine how hounded the staff in primary care doctors offices feel about all the paperwork to refer their patients with UHC to specialists.
I haven't finished watching the video to see if Phil mentions this, but the original Pro Publica article mentions that the guy who headed this project at Cigna did it at UHC first. 💀
Advice as someone that used to work for Cigna, always, ALWAYS call in. Do not accept the denial outright. The contact centers will do whatever they can to approve your cases or to have your cases reconsidered/ appealed. Also, keep the contact center representative’s by getting names & any reference numbers they give you.
My boyfriend lost his medicaid in February because he "made too much." He made $9 an hour +tips (in Idaho) which varied a ton. It's still not enough to live off of. Thankfully, he got a new job that pays $15 an hour and has health benefits, but he has not been covered for a couple of months now and will have to wait until his work benefits kick in (60 days). This is definitely going to have some awful effects, and people will suffer without any insurance.
My father has ALS, which is a crippling and awful condition, and Cigna denied his medication refill for a month because his doctor didn't say that it was improving his condition, just that he needed it. The problem is, medication for ALS doesn't 'improve your condition' it just delays the inevitable. In that time he rapidly lost the ability to use his right hand and he will never regain full functionality of it again.
I'm not from the US but I can tell how important this information is for people and its wonderful that you're out here trying to help as many people as you can in the only way you can.
It's even worse for people who are pore. Even the affordable healthcare act (obamacare) you have to make at least 14k/year i make min wage in my state and they only give me 32hrs a week (not 40 so they don't have to give me benefits) i literally made 13k last year. so i don't qualify for the ACA i'd have to pay full price for insurance. I can't afford that, so I just basically "tough it out" any time i get sick or injured
All this does is give people more reason to trust Crystal Mommies and Liver Kings to tell them how they should address their health. The American Health Care System is such a scam, I sincerely do not understand how this is allowed.
because the ones who make billions off of it have tricked the public into thinking single payer heathcare will leave them dead in the waiting room, when that happens under our current system,
This literally just happened to me TWICE: Last year I had a baby in June and the hospital decided to run a test when I got to the ER to see if my water had actually broke (bc me telling them it did wasn’t good enough?). Months later I received a letter saying that it wasn’t medically necessary and they were denying coverage. At that point I had already over paid so I was unable to appeal bc they say my “payment” as an agreement to their decision. Then last week I found out they decided my dr visit from Feb was a specialist and I owed the dr the difference in copays. Apparently their AI decided that all Nurse Practitioners are specialists and all care provided by them should be billed as such. Still waiting on that appeal to go through. I’m tired of Cigna (and all insurance BUSINESS for that matter) and I wish I could choose the best coverage option for me rather than my employer deciding to cheap out and give us crap
For real! I can't get on disability because they think I can work, but I can't and i have had 5 doctors write me letters. At this point my husband just try to plan our future around our impending bankruptcy. Or car is about to die but we are trying to wait until after we need to declare so that they can't take a car that works from us. Edit:I have insurance and my husband doesn't make bad money. It's not great but if I wasn't so sick we would probably own our own house and such
Even being on disability is fucked up. It is literally ment to keep you in the poverty population. The government checks your banks account every month to make sure you have no more than $2000 dollars in your account. You want to save for a house, car, service dog, customized electric wheelchair your fucked.
@@foxxxyg feel this so much. I am fortunate right now that I am supported by my family enough that I don’t have to get on disability right now. But it’s a crap shoot if I do get. Only about 25% of people with my disorder get it when they apply. I’m a little more hopeful because now there is an ICD- 10 code for it so hopefully we will be seen more
@@tiffbeevachou108 It's related because often the choice is attempting to get disability or attempting to find an insurance that wont charge you out the azz for said disabilities though.
As someone who had recently gone through vitamin D deficiency and had to get a blood test for it I went through the exact same thing. I was required to give out the documents leading to why it was necessary(Which I was told I could provide easily with the test results themselves) but due to everyone explaining "This is what you have to do" in their own way I ended up getting fucked over and had to pay out despite multiple attempts in appealing it. Being told multiple things from both the hospital and insurance company was fairly infuriating.
We had Cigna do this over many years and I had no idea it wasn't supposed to happen. My husband had cancer and they have continued to automatically deny him for almost every remission CT scan. They said the scans weren't "medically necessary" even though he had a nurse assigned to him and he used Cigna insurance through his entire cancer diagnosis and treatment. We ended up paying thousands of extra dollars that should have been paid by insurance just because we couldn't keep up with all of the denied claims due to the sheer amount of medical treatments he had to go through. He was also denied for a PET scan his doctor wanted to do, which would have allowed us to see his cancer wasn't all gone months before we found out through other symptoms. It delayed his treatment. I can't imagine someone trying to go through that alone if they didn't have a family member helping them with insurance. For years I have said these doctors denying claims shouldn't be able to deny a claim without seeing the patient. I truly believe it goes against their oath to deny a patient treatment ordered by another doctor without even seeing them. They should have to look a sick person in the eye and say they aren't going to cover treatment.
My sister and I have been denied surgery to fix our severe underbite because they said “we weren’t born with it” as if we were born like that. We had extensive documentation about our underbite from birth and going to the orthodontist for several years. They said it’s “a cosmetic surgery” when in reality it could greatly help our speech, eating, breathing, etc.
Have the same problem, the work around is getting diagnosed with sleep apnea as a result of the underbite. However, getting insurance to pay for the sleep study is almost impossible, and a sleep study is almost the cost of jaw surgery to fix the underbite, so you're kind of stuck. If course, if you go to your doctor about your trouble breathing and mention your concerns, they could help you out on getting a claim filed with your insurance.
@@vio_lin The surgery is seen as cosmetic at this point from the insurance since we have been fine, but in all honestly, it does affect my speech. Without insurance it will cost us 20k each which is far too expensive for any surgery and let alone for two people. We have tried braces, head gear, etc, to stop our jaws from growing too quickly, but they didn't work. The orthodontist also said we would have to wait until we were done growing to have the surgeries.
Philip! It’s episodes like this that reinforce that you are literally saving peoples lives. As someone with lifelong chronic health struggles in my late 20s, it warms my heart that someone with such a wide audience cares so much and is willing to put the effort in to help the masses. Although Canadian healthcare isn’t fantastic, at least I don’t have to deal with insurance anarchy. Love you dude! Keep rocking
I have worked in the healthcare industry, front office and IT, for a decade, from both the hospital, urgent care, and the insurance side, and what I have seen is just disgusting. I finally quit my corporate healthcare job recently because I just couldn't give my soul away to such a hurtful industry anymore. The American healthcare system is absolute bullshit and just wants us to die and leave medical bills to our families. For anyone still in the healthcare system I am sending you love and gratitude that you continue to work to help patients in anyway you can. Just take care of yourself first and know when you time is up in the industry.
There's a great video by Evan Edinger that just compares the price of healthcare in the US to the cost of the same treatment on the NHS in the UK. It's no exaggeration to say that Americans are often paying between 10 and 100 times the actual cost of treatment.
I think the worst part is realizing it is from all sides in the industry too. l hated having to go to bat for insurance companies when I worked at one because I saw all the ways providers were taking advantage of patients. I also hated later realizing that some of that is a result of the messed up stuff insurance does. And the cycle continues. What makes it sadder is that the vast majority of people don't actually understand what's happening and a lot of it is a result of someone somewhere lazily forgetting or not caring that their choices are impacting real people. Now, I just warn people to be vigilant about their billing and EOBs, it's the only way to protect yourself. :(
I’m currently fighting with Cigna because they denied some of claims because they’re claiming my provider suddenly in network when they are. I will get a lawyer if I have to and file a complaint with the state.
I'm so happy to see someone cover this. My FMLA claim through my work insurance was denied and I struggled with is for months while I recovered. I appealed twice with no success. I eventually quit because I couldn't work for a company that wouldn't be willing to help me when I need it.
The exact thing happened to me last year! I was suddenly with NO INCOME while trying to recover and was almost evicted trying to keep my head above water - even though I just wanted to use the benefit I had already spent 3 years paying for? Had to come back to work early and spent the entire time applying to new jobs - I have my dream job now but that experience was traumatic. I’m so so so sorry for them doing that to you too.
This happened to me too. Was told later by my case manager that if I had mentioned I was prescribed a medicine my FMLA claim could have been approved. As if that's not my medical provider's job to include all the details of my case.... Something about being told after the fact what I could have done to make approval more likely really stung. Like wow, if I knew this not 3 weeks earlier I might still have my job, thanks so much
FMLA is such a huge pain in the ass, I swear that my Dr's office fucks up their side of paperwork every single time; not only that Lincoln gives me such bullshit excuses, yanking me around. It just took me almost 50 days to extend my intermittent FMLA with them both, fml.
@@herefortheshrimp1469 i used to work for insurance companies for like 15 years… not only was the work boring as shit. But not a single person cared about the customer one bit. All everyone cared about was ensuring everyone paid their premiums, and how we can get more healthy people to sign up for insurance. The only time something “positive” was said was when the execs would tell us a story of a customer who got paid… acting like a handful of people getting paid was a good thing.. if you need insurance you cant get it because you need it… if you dont need it the insurers are ready and happy to cover you. I always said insurance is a fucking scam for 9/10 people. I literally work in a call centre now doing collections… but the company cares about the customers we have tons of options to help the customer not obliterate their credit. The company cares about its employees and i feel valued and i feel like even tho my job is to collect, i have the ability to help people with their payments and it feels like at least i can help. I will never work for insurance ever again lol fuck that shit, let these greedy fucks get their robots to do all their work. (The old job i had also got rid of all their customer service team and sent it all out to india, because they can pay someone there 1$ a day vs 15$/hour in canada. I have zero respect for insurance companies.
My husband’s jaw surgery was partially covered because without it he’d eventually develop arthritis but the adult braces he needed to qualify for/get the surgery were deemed ‘cosmetic’ and insurance refused to cover it 😡
When I started working full-time in 2013 I got my own insurance for the first time. They denied EVERYTHING for the first year, usually as a pre-existing condition. I just believed them because I didn’t know any better. Then I got a piece of wood in my eye and had to go to the urgent care to get it removed. That was ALSO denied as a pre-existing condition. When that happened I finally called because I knew the eye injury wasn’t pre-existing and they basically told me “yeah, we deny everything for new customers because we have no records and don’t know what’s pre-existing or not.”
United is doing a similar thing! They have denied one of my routine ultrasounds several times...all because my doctors office "didn't get preapproval" so they deemed the procedure "medically unnecessary." So even though its normal to get an ultrasound at 32 weeks to check the size and postion of the baby to help prepare for the delivery, they won't cover it because no one asked them first 🤦♀️
My favorite part of this scam is that the providers' contracts with these scumbag companies say that coverage decisions can "in no way" be considered as influencing medical decision-making and treatment decisions. It's such horseshit. I used to work at a billing company serving small doctor offices and it used to feel like we were helping them, but the endless wild goose chases to get claims paid got so ridiculous that I burned out hard and had to leave the field.
This was the story of my life for years while fighting with Cigna to get neck surgery that I desperately needed. At every. Single. Turn. we would end up with a rejection letter from Cigna showing up in our mailbox. The doctors weren’t even surprised when we told them, they just knew to automatically appeal on our behalf. Sometimes we had to appeal FIVE TIMES to finally get something covered. It’s crazy to me because Cigna is considered one of the good insurance companies too, but they’re doing stuff like this to countless people…
I’ve been screaming about insurance since I first started working in the hospital. I can’t tell you how many people I had to send home without what they need. I’m so tired of fighting every step in the system.
I was initially denied for my cesarean, which was done under emergency circumstances. The insurance company claimed it was not medically necessary, but the doctor who made the decision stated that I would have died in childbirth if they had not done the emergency cesarean (without going into too many details). My husband actually accused the insurance company of preferring to orphan three children rather than take care of their mother. It took almost two years to finally get our claim approved, and really only after our lawyer basically accused the company of the same thing my husband had.
Got Cigna through my job 6 months ago. I've been fighting with them for those 6months to get them to cover my asthma medication. They initially told me they denied my claim because it wasn't pre approved, even though the medication is part of their formulary AND I'd been seeing a doctor for it since 2016. Then they made me and my doctor do the jog of here is all of these other medications that don't work for you but we need you to try anyway. Fun fact: they tried to block my ability to pick up/cover the cost for those medications as well. Now they just hang up on me when I call to reappeal their new denial for the medication that works for me. When I finally do get a person on the phone I'm told "your doctor needs to send in a pre approval". We've sent in 4-5 at this point, where did the last 4 go? My doctor and I are both sick of Cigna but there's no other choice as it's employer health insurance. A lot of my coworkers have similar issues and have had to supplement their insurance with state insurance to cover their healthcare. Cigna is by far the WORST insurance I've ever had to deal with and in the future when applying to jobs I'll do my best to avoid any company using Cigna.
yea but in places like Alberta Canada specifically we're becoming ameribrained and our governments actively stripping our healthcare funding ramping up for privatization
What if we just made gofundme a nationally subsidized platform and called it “universal gofundme” and just had everyone pay a percentage of their income into it and.. oh. Wait a minute.
@@bigandhairyrichard6333 that's not a Free Healthcare issue, that's a leadership issue. Free Healthcare works, but it needs to be funded. New provincial elections are coming up for Alberta. Time to vote out the Cons.
This is wild. I have Cigna. I’m supposed to be going in for surgery within a couple of months. The Cigna rep I spoke to said that my surgery was covered by insurance. I hope that they don’t deny my shit once I go in. Thanks to this I’m going to fight the case if they decide to fuck around.
Hi Alexis! I work in healthcare and deal with insurance providers all the time. PLEASE contact them back and ask them to send you a letter with WRITTEN APPROVAL so you're 1000% covered later down the line closer to your surgery date. Don't take what a random rep says over the phone as gospel, not every call has recorded notes and that can give them room to simply state it was never approved in the first place
☝️yep - and even then, prepare yourself to fight it. I had written approval for a breast reduction and my surgeon called my two weeks after to let me know insurance decided to only pay about $2000 of a $12,000 surgery - and that was after my own $4000 deductible. Fun.
I know, just look at everything you had to go thru just to cover cancer treatment! The ONLY positive thing the broken system did was provide a logical premise for Breaking Bad. Which is more messed up than anything that happened in that show.
I purchased an injectable medication for my wife about two weeks. I asked what my copay would be and was told it would be $25. Yesterday I received a letter informing me that I was under billed for the drug and that I now owe them for my wife $321.91. The pharmacy ran the drug through the Cigna computer, as is always the case and their computer or contracted computer tells the pharmacist what the copay will be. I relied on this figure given to me before purchasing. So if this amount is paid this one drug will account for 15% of her monthly social security check. We have other drugs that she can not do without! So this means any Cigna member can go to the pharmacy pay a $20 or whatever copay and two weeks get a letter,” we undercharged you, you owe us $1000! I am a retired pharmacist and have never heard of this happening. We have personally had Medicare d for several years and this never happened with the United Healthcare (aarp) plan or the WellCare plan!!
I work with a third party benefits administrator and oh my god the Cigna story explains SO MUCH. We’re dealing with so SO many denied Cigna claims and now we know why! If you get your claim denied, CALL YOUR INSURANCE AND PROVIDER IMMEDIATELY
My husband started working for a company that used Cigna for health insurance. A few months later, he was on a trip (personal) and he was injured (oil burn while cooking), resulting in a trip to the ER. He used insurance and about a month after the incident, he got a letter from Cigna asking if it was a "workplace injury" and talking about how he would need to go through his employer if that's what it was, and that if he didn't contact them, they would assume that it was a workplace injury. We were like, WTF? He was nearly 400 miles from home, on a vacation, and burned his hand while cooking over a campfire. But Cigna was going to assume it was a workplace injury unless he called them? We have never before experienced an insurance company behaving like that. It was nuts.
This may be an expose on Cigna but they’re not the only ones who do this! I have heard so much behind the scenes of this happening at Aetna, AIG, etc. insurance companies thrive on a denial culture but the employees are not allowed to admit it!
Absolutely. Before prescribing any medication that isn't generic, and even after checking the formulary for an insurance company, you can't always guarantee that it will be covered. All of your doctors offices have at least one person on staff who spends most of the day making phone calls and faxing letters and other forms of jumping through hoops to try to get even basic stuff covered for you. And when the medication needed is something that costs tens of thousands of dollars per month, like the newfangled "biologic drugs" and what not, it's automatic, that it won't be covered and it will take weeks to months to get approval, if ever. There would still be a certain level of this if we had universal healthcare, obviously, but there wouldn't be 20 different sets of rules
blue cross blue shield of alabama literally destroyed my psyche for a period in time 😭 i went through hell with them, i have no insurance right now & im dealing with less bullshit than when i had bcbs and cigna
@@bri6032 -- BCBS can be tricky, because some versions in some states are nonprofit, and other versions in other states are for-profit. Definitely the nonprofit versions are better, but even they will give you the runaround with prior authorizations and things.
Until states start enforcing rules against these companies nothing will change. Washington state for instance mandates that insulin and diabetic supplies cost a maximum amount. Insulin is at a $35 copay for 30 days.
I had Cigna for a very short time last year through a previous employer and experienced the same issue with them denying my mandatory medical needs and had to pay out of pocket. I abandoned ship so fast and am happily with BCBS now. Well, as happy as you can be with any major health insurance provider.
As an insurance agent who deals specifically in Medicare Advantage for the last two years, I’m not surprised at all. I am one of the top Medicare insurance agents in the country (based on personal enrollment numbers) and have worked with the largest broker GoHealth as well as other major brokers of Medicare Advantage. I have sold for Cigna, Aetna, Wellcare, Humana, UHC, Kaiser, Molina, and others. The amount of fraud and scams that agents do to convince people to join insurances is insane. Lying about coverage amounts, copay’s, deductibles, etc. and then the insurance company is screwing them on the back end. It’s insane. Sad to learn that these people are getting double screwed.
Lol I knew it. I had Cigna the last 18 months. $600/month to cover my family and I desperately need a couple medications but it took months of appeals and eventually me just giving up and saying I’d pay out of pocket. So I’ve been paying $600/month + $150/month for medications (thanks GoodRx! It would have been another $400 even generic) and another $160/month for therapy. I actually pay $600/month for them to cover essentially nothing and our family deductible is $4000 and unless there’s an accident, we won’t meet that. Edit: also why are states kicking people off? Do they realize they could just… not? We make up all these lame ass rule and they choose to hurt instead of help. They hate you.
As a hospital social worker: I am always enraged by insurance. Our PT and OT department has to be careful how they document or it will disqualify patients from care
My former job required me to fight Cigna to pay claims, we didn’t push denied claims to patients we would fight for years to get claims to pay. It was so exhausting
I had Cigna for dental and I dropped them after they kept not auto-renewing my enrollment every couple of years, forcing me to re-enroll and resetting those damned "waiting periods" for procedures. That caused me to have to pay out-of-pocket for everything from basic cleanings to routine exams because their waiting periods requirement hadn't been met, despite the fact I'd had their insurance for several years. After the last time this happened I dropped them and switched to Delta Dental. So far they've treated me much better.
I work in healthcare management and I’ve experienced so many claims and appeals being denied. Something I’ve heard from reps that they automatically deny first claims to force people to submit a second appeal which is the last type of appeal. There have been so many claims that get automatically denied due to a diagnosis and procedure code being supposedly unrelated, even for preventive visits!!!
Thank you for covering this topic. I work in billing and coding and I have seen and experienced some of these insurance problems and it kills me that people don't know to appeal. Call and ask which MD made the denial. If the Insurance company can't prove that an actual MD made the denial and you argue that it's practicing without a license they will, 8 times out of 10, turn around and approve the procedure. It's horrible and so many die from the way that insurance companies in the US handle these claims.
We have to move to national single-payer 'medicare for all' model. It's more cost-effective (appr. 2-3x moreso) and it results in better outcomes (barring a few niche treatment areas). Set aside ideology and just think about the economics & the moral value in a preventive care model. The USA model is profit-from-suffering model and especially since wages, adjusted for inflation have no risen for more than 50 years, it's unsustainable as is. The entire 'free market' nonsense doesn't apply to healthcare and it never can. Our HC cannot be assessed via traditional supply/demand interactions. If we look at just three things in the USA. a) rising costs of HC b) rising costs of education and c) rising entry level home prices. ...a simple review of those things in relation to wage-n-income makes crystal clear we cannot continue the trajectory we are on and all this right vs left tribalism is simply a tool to keep us divided while corporations exploit us every single day in this country. Don't believe me? just ask those bankrupted by HC bills (even those with good insurance)...since HC is BY FAR the #1 reason for bankruptcy in the USA. Sure, there are things we can disagree on ideologically but health care does not have to be one of those things - quit drinking the lies told to you by politicians and those who profit from suffering.
im in canada and applying for disability. my lawyer, who is helping me appeal the denial i received after waiting over 145 business days for an initial decision, told me 90 percent of applications are applied even if you have a strong case because most people give up and dont appeal. he also said the request for internal review which is the first step after a denial is usually denied as well and have to go to the social benefits tribunal where i could be waiting another 8 to 14 months from today.
Wise move releasing this on the weekend so as not to demonitize the week day shows. Edit: Loving the deep dives into news that affects me instead of the famous people shenanigans we get sometimes.
EXACTLY! I'm so tired of hearing about dumb internet drama no one cares about. Tell me how my government is screwing me so we can get angry enough to attempt to change it.
As a Canadian I also feel like it was wrong that my classmate from uni’s sister under 20 had to wait 7 month to get treatment for cancer. Now that’s completely unheard of in the USA
@@spritedrin No it isn't. It's quite common actually depending on what part of the process you are talking about. Wait times to see any kind of specialist is very similar in Canada and the us. I know, I have family in both the us and Canada in multiple provinces and states. Obviously there was issues with the pandemic that changed things but that's got nothing to do with the effectiveness of either system. I know you think that US hospitals have 500 teams of doctors and nurses with an entire army of staff just waiting at the door for a patient to arrive and nobody ever waits for treatment but that's totally false. In both Canada and the USA the treatment available and the wait times to see a specialist or if there is a specialist available varies widely depending on the area and the population density of the area.
@@spritedrin it is extremely common here in the US, stop listening to conservative propaganda, they are trying to get rid of your health system for profit. I recently had to wait 6 months to see a neurologist, and because I don't have insurance most doctors won't even see me.
@@joer8854 I live in the Us and work in the hospital and experienced both Us and Canada . Everyone’s experience is different but Canada isn’t as good as most thing it is
@@MikePerreman idk where you are getting 70k from. My husband has 2 emergency surgeries back to back for 2 years and max we spent was $7k the first time bc he bought the cheapest insurance and $1200 the second time because we bought better insurance
Hmm. I bet that’s why I’ve had a rejection due to “unnecessary testing”, despite having a referral, testing, then needed a referral from someone else, who then said they wouldn’t refer me because that’s my psychiatrist’s power, mind you, my psychiatrist being the original referrer, and the insurance claiming to cover testing Luckily me and the neurosurgeon are fighting to repeal, because there’s no logical reason the test cost would not be covered
Imagine those working in healthcare insurance billing compliance like myself that have written reports and audits for years for things just like this. Where do the audits go? I've been in the medical field since the 90s. HHS (health n human services) and CMS (Medicare) can be contacted as well and fraud reported right on their websites. Issue is far too many people call the insurance company, the very entity that is causing their issue in cases like this.
I used to work for Cigna through a third party call centre, I was once suspended for sending a "strongly worded" email to a claims processor whose biggest gripe was that it included the word nonsense because they kept sending at members check to the wrong address, I was suspended for 3 days
as someone with chronic heart problems dealing with the medial systems can really destroy your self esteem but i want to tell everyone to remember to keep pushing for what you need! awesome of Phil to tell people to appeal these claims cuz they are counting on you not. this is so incredibly true. the squeaky wheel really does get the grease in this industry.
You have no idea how much I appreciate the daily shows. It keeps me off the social media doom scroll and it’s something I really look forward to that it becomes part of my routine. Probably intentional from Phil and his team, and I’m sooooo grateful ❤️
Regarding the Cigna segment- as someone who works for an insurance company similar to Cigna, though not specifically in the claim department, I can confirm there is more than 5% for appeals, but not enough. My company is usually pretty good at catching issues with the algorithm, but still runs on a 20 year old system for claims processing…
I'm so tired of people thinking it's SO EASY to even just update your address with Medicaid. If you're on Disability, you have to go through the SSA to get that changed which means waiting for hours in an office or on the phone. Every single time I have tried to call to update my address in the last year I have been unable to get to a real human person who can update it. All of the Social Security offices within 30 miles of my location were closed during the pandemic so I can't just go in person either. This system is so much more broken than you even realize. You can change any information you want online with social security... except your address.
My daughter was insured under her step mom.... Cigna and my insurance BCBS. She owes 9k now and every week it goes up with back claims finally being processed. She's 19. She just wants to not want to feel like she wants to end her life. And this is how she gets the help, sorry you owe us 6k we can't help you aka they're just telling her to off herself. She found a new doctor and same thing, after a few weeks they couldn't give her meds or see her anymore because insurance wouldn't cover. Now she's in medicated with a bipolar, ptsd and I forgot the exact word for it but a multiple personality disorder of some sort at 19yrs old. She can't work, she can't get a diagnosis for meds ans now she owes 9k and I have to worry about elher every single day. Eff the medical system!!!!
Ever watch one of those movies where a local gang or mafia "offers protection" to neighbourhood stores? The main difference between those thugs and modern day insurance is that the thugs have some motivation to keep the local economy running, and accountability has real life consequences. Insurance is basically legalized theft.
My dr: here’s a script for a new med for your debilitating migraines. Insurance: nope. Try those other meds(again) Dr: here’s a script for those “other” meds Insurance: also no. Me and dr: 🤯🤯🤯🤯 Thank you for covering this!!! I’m so tired of paying nearly $10k a yr for my family and STILL needing to depend on manufacturers “assistance programs” to get meds I need esp for my mental health. It’s a sham, y’all! All a sham! They ALL bank on you not appealing. Appeal them all!
It amazes me that a company that is made of non-medical professionals are allowed to make decisions that directly affect people's health that undermine actual medical professionals' decisions. Insurance companies are literally playing doctor without a license.
I literally said this to my sons speech therapist! How can they tell me what my son doesn’t need when they don’t even know him 🥺 I hate it. We appeal but still. It frustrates me to no end.
This is how I feel about our legislators signing away our reproductive rights too. Most voters aren't medical professionals, and over half of our elected officials never even need to worry about giving birth. Although, what insurance companies have that our legislators don't: paid doctors to approve these claims. Giving them one button to deny hundreds at a time is beyond negligent.
RIGHT?? And doctors also don’t decide if people get disability, either. Judges do!! It’s immoral!
Welcome to america.
Sure, you say this, til Tucker Carlson wants you to pay for his infrared teste-therapy visits and people start getting blepharoplasties to take their eyebrows up 3 inches on your dime. FR though an MRI should be free with insurance once a year tho. It's insane that they throw imaging so many roadblocks. It's a gd diagnostic tool
I have Cigna. They denied the anesthesia charge for a recent back surgery. Apparently, anesthesia wasn't medically necessary...for surgery.
That should have been the nonsense regulated by the government.
because it wasn't a person reviewing it but a computer program it seems
😮 wow....
CIGNA is definitely one of the worst in terms of automatic denials, but almost all the insurance companies are guilty of rejecting charges for things like anesthesia or radiology services that might happen during surgery, because often a hospital will have a person on staff (or a contract/locum tenens worker) who doesn't take a given patient's insurance, and they don't check ahead of time to make sure that everyone on the case is a participating provider.
Sometimes, even if the patient calls ahead of the procedure to the insurance company, and confirms that the hospital and the surgeon are "in network" for their policy, they don't know which anesthesiologist is going to be working the case at the time that they get the approval. And quite frankly, how many patients even think to ask about such things?
And it is much much worse for emergency services, when there's no possible way to call ahead of time to confirm coverage.
One of the many reasons that we need universal healthcare
I sure hope you appealed it.
Hearing "not medically necessary" is so triggering to me now. I have been in pain for years and so many things have been denied on the grounds that it was "not medically necessary." It's horrifying and makes me miserable.
@@MikePerreman Oh you know those doctors. Suggesting things to keep your healthy and pain free. silly doctors! Thinking being healthy and pain free is medical necessity.
@@MikePerreman EXACTLY
In the same boat. I'm so angry, I'm so under treated. I am so disappointed that our people aren't fighting together to improve our system.
Bro you are falling for this world matrix, when will we all just stop following these fools that rule the world from the shadows like a bunch of cowards, we out number three by a lot when will people take back the power we should have 😢
Right there with you. Fighting to get care most my life
My bio Dad had stage 4 COPD. He was on a wait list to get a life saving treatment. It was finally his turn, and his insurance denied it twice. He passed away 3 weeks ago. It’s heartbreaking when these companies care more about making billions than human life.
Sorry for your loss. Change needs to happen
So sorry to hear this. It's criminal the way humans can treat each other..
I know this is a really tough time for you but you should sue them. If nobody holds them accountable they're gonna keep doing it. They're gonna keep killing people's family members.
@@taylorbug9 it’s true, I know I have had issues in the past because of insurance. Thankfully for me, I was able to get Medicaid and thats made things better, hopefully I don’t lose my insurance because of the policy expiration, I enrolled on Medicaid during the pandemic….
Makes zero sense that we don’t just provide everyone healthcare like almost every other country.
@@taylorbug9 Sue and appeal to the supreme court that this is violating the entitlement to life under "Life, liberty and the pursuit of happiness." the court won't by it but the more people who do this the more trouble we cause for companies like cigna.
Healthcare execs need to go to prison for this. Imagine the amount of people who had to go through excruciating pain or even died because their claims were denied and they weren't able to access the care they needed.
Class war must be waged against the billionaires and evil corporate interests that have their foot on the necks of working class people.
Maybe, just maybe, our "healthcare" system is shit and Healthcare shouldn't be a for profit business.
Nah, some idiot will see this comment and immediately say free healthcare is “impossible” And help road block meaningful changes.
Indeed
It's too late now. So much money is being profited from health care that to stop it now would send our economy into a tail spin. Nearly 18% of the US GDP is the Healthcare system
Whoa, slow down there Marx! Think about what you're saying /s
EDIT: FYI for those that didn't know, "/s" implies sarcasm.
Makes too much sense. So much sense that American Politics don't give af
This hurts my heart so much. My previous employer changed insurance companies to Cigna at the start of the year and they refused to cover my medicine that was already approved and paid for my the previous carrier. They wanted me to start paying $137 per pill out of pocket, which was just way out of reach for me. I got so sick of fighting them I eventually ended up changing jobs to get better insurance coverage. Now I am questioning if my case was ever even reviewed by a real person.
It probably wasn’t :( I’m sorry. That’s fucking insidious.
It most certainly wasn't, and I'd honestly look into suing them.
I hope there's an actual, European-style lawsuit for this. Not an American lawsuit, where they get hit with a fine that's about 2% of the profits they got from the crime. I'm talking about completely liquidating the company, putting everyone on the board in jail, and redistributing all the money gained to the people who were affected.
It isn't going to happen. But I really wish it would.
@@dianaw4072this is exactly why I don't have health insurance. For a family of three, I'd be paying $800 a month, and our medical bills only total about $300 a month.
Do they seriously think everyone just has an extra $500 every month laying around?
it probably wasn't I'm so sorry, learning about this means my necessary medications weren't payed for either and my mom probably payed out of pocket
I work in medical billing. Regarding the denials due to "medical necessity", 9/10 it is NOT YOUR DOCTOR forgetting to leave something out on your clinical documentation to indicate the need for what you had done. It is the insurance. I've been noticing insurance companies convincing patients to come back to us after we advise them to file an appeal with the insurance. They don't want you to file that appeal. Force them to let you file it!! They cannot deny you that right. Many people come back and yell at us saying the doctor needs to submit it as medically necessary but again, 9/10 it's not that anything's missing it's that your insurance is telling us they disagree with your doctor's professional diagnosis.
The system is fucked beyond all reprieve.
My favorite line from patients is "the insurance company said you coded it wrong." OH really? How should I have coded this claim that I have coded the same way with no issue for the past 200 claims? What's that? We at the insurance company can't tell you how to bill? But you can still say we billed it wrong.
Exactly! I work in the same field and the insurance tells the patient that we never submitted the "additional information" that they requested when we always do and the patient is left feeling like we are lying and not doing our job. I mean seriously, it is in our interest to get approved for a procedure.
@Osan Naso omg spot on! It's so triggering! And then you speak the claims department and they can't do anything, they don't understand anything and can Give you no way of how to fix their issue
@@osannaso5613 My insurance told me my mammogram was coded wrong. I called the office and they were like... no honey I promise it's coded correctly. Who denies a mammogram??? Nobody out here getting their boobs crushed for $500 for fun. I didn't know the coding thing was a lie they tell for rejections often.
I hate insurance..they denied my claim that my child's wellvisit was covered claiming my doctors office wasn't in-network even though their certificate says otherwise. They suck so much.
Cigna is not the only insurance company doing this. I worked as a medical receptionist for years and I stopped working in this field because of how difficult and demanding it was to deal with insurance companies on a day to day basis. I was calling on behalf of the doctors prescribing the medication, treatment or testing and it was still next to impossible. It was clear that the job was to find ANY reason to deny coverage to the patient. What I learned was that your doctor doesn’t really decide what treatment you receive the insurance companies do. Don’t even get me started on monthly pre-authorization for medications that keep you alive or that cause less side affects!!
Same. I managed an insurance department for 6 years before I finally broke and left. It’s mentally exhausting to come home every day after dealing with these companies
@@xena2shoes 100%! I used to come home and have to basically sit in silence for an hour just to get my brain to stop! ❤️ thank you for the comment as well!! I really struggled with not beating myself up for feeling like the job wasn’t worth my mental health anymore.
This! I literally tell people I get to yell at insurance companies for a living. It makes my day, week, and sometimes month when I finally get them to pay what they actually owe!
It took me just over 5 months of constant pestering, appeals and calls to the customer support line to FINALLY get a near $10,000 bill to go through my insurance and have it properly covered.
I got a "nice" letter from my insurance basically saying their decision was final, it was reviewed and I'd have to owe a bunch of money that I just KNEW I shouldn't have needed to pay. I made so many phone calls on lunch breaks while at work and during my off days for months. So many written appeals I lost count. I was at my end. I was almost done fighting and almost gave up. I was days away from giving up when I finally got a notification that they were covering a huge portion of my medical bills.
I remember getting the email notification that a new statement had arrived. I assumed it was another denial and a new bill. To my surprise it wasn't. The relief I felt is indescribable. I wanted to cry both from the financial relief, but also because... Nobody should ever have to go through that. At ALL.
So when I hear these kind of medical stories, I know I am not alone but that others had it worse than I did. It's extremely sad and disheartening that this stuff occurs. And to think how many people either just pay up because "well they know best so they must be right" or because they'd rather pay than fight it.
It's sad this happens. Sad is a huge ass understatement.
Cigna denied my meds 6 years ago, preventing me from getting treatment for my newly diagnosed ms (the other treatments were either dangerous for my other conditions or unnecessarily painful for me). We fought it for 6 months and they held firm I should try the more dangerous and less effective treatments first.
I ended up having to get into a research study to even be able to afford my meds.
what treatment where you trying to get on? I also have MS and have been on a few over the past 16 years
I'm lucky to have an oncology team that stands up to my insurance company. My husband gets insurance payments taken out of his paychecks, so it's not even as if insurance comes free with a job. You basically have to have a job to get into a group, and we still gotta pay out. At least isn't not as expensive as private insurance outside an employer's group. That said, even though we pay for it, the insurance co tried to increase my Letrozole dosage just for them to save like 50 cents. It's a cheap cancer drug, but nobody wants more of those side effects than absolutely necessary.
Thats incredibly heart-wrenching that in order to get proper treatment, you had to make yourself into a research subject. Im glad you got the treatment though
This is so awful and so common.
Not to mention that every research has control groups and you have no guarantee of not getting just placebo pills 🤦🏻♂️
Phil, thanks for covering the Cigna issue. I am a clinician practicing in chicago and have had nightmares with them for years. Currently treating a patient with Cigna who had an awful stroke. We are literally doing rehabilitation to get her to walk, run, and be active again. She is 29 years old. Cigna has upheld that any care is "not medically nessecary" for the past 8 months. Not medically nessecary to return to normal life following a medical event. The system is a joke. I wish i could say this was an isolated incident for us. Just the most recent status quo.
I won’t go into the long, horrible story but Cigna played a huge part in why I quit my last job and was almost evicted last year. I am unbelievably unsurprised and still livid. This is THEFT AND TORTURE
What happened?
They dont care, get out of America
I had to pay $300 a month for a medication they refused to cover even after appeal.
Did you work for an "internet" provider?
Hope you're doing better now ❤️
This is exactly why I believe that heads of corporations should be criminally charged for perpetuating systems like this in their companies. The only way ceos are going to change is by threatening them with prison time.
You can’t criminally charge them if it’s perfectly legal. Gotta change the system first
I'm a hospital social worker who has to wrestle with Medicare Advantage plans everyday. I promise this is just the tip of the iceburg. So impressed this is getting attention from Phil. The system is so broken, and most people don't figure it out until its too late.
I have had MA plans for years as a person under 65 on Medicare. MA was the only option available to me in the state I live in (as in most states). I absolutely hate --- hate--- MA. It nickels and dimes you to death. I had a ruptured disc last fall and the surgeon told me he'd have to try me on pain meds, wait at least two weeks and have me do PT. (at least one or two sessions) before insurance would pay for an MRI. I did all that -- in pain--to get an MRI that showed enough damage to warrant surgery.
The insane part of this is, the articles want you to ACTUALLY FEEL BAD FOR THE INSURANCE COMPANY!!
Because the people writing them are as inhuman as the insurers.
I hate it here.
I once actually went through the numbers behind my retirement plan and even if I got to live up to 100, I'd have more by depositing that money and later just directly withdraw.
theres a subreddit r/OrphanCrushingMachine that highlights this sort of thing
When i see sh_t like that, I write to the company that wrote the article and I shame the f_ck out of them.
As a Brit, I feel so lucky that I never have to deal with Health Insurance. The UK kinda sucks and the NHS isn't perfect but I never want to go through what people in the USA do to get treatment.
The NHS is only so bad now due to the Tories trying to destroy it as they want to introduce this to make their mates billions.
I watch you too. I'm absolutely terrified because this is my insurance. I want to be able to live, just live, without debt and fear
@@katrinaf248 good luck, I recommend dropping this company
You know we’re about to lose the Nhs right? , we didn’t listen when the doctors and nurses went on strike……#tories
I hope you guys in the UK can prevent those who seem hell-bent on destroying the NHS from succeeding. As an American, it's hard to not look at some in your Government and see them as anything but paid advocates of moving you to the American system for the sake of the greedy who want to squeeze profits out of you like they do here - while still underpaying the doctors and nurses that are doing the actual work.
Its crazy seeing this because I used to work for them. One time I was helping a health care worker try to get a claim approved for a hospital visit for an infant who died during childbirth. The reason the baby wasnt covered is because you have to claim them after theyre born but they were dead so they couldnt do that. They were fighting for this appeal for over a year after the babys death, they owed almost a 200k without approval. It was fucked up
That's disgusting. What happens if you just refuse to pay it? Or set up a payment plan and say I can only pay $5 a month?
@@breezyncj Depends on the company/state, but most of the time, they'll send it to debt collectors who can put liens against you, your wages, and your property if you own a car or house. Over the death of your child, you could have your house taken from you by the hospital. Its that fucked up.
Absolute insanity isn't it?
Stories like this make it difficult to avoid advocating for serious physical harm against these people. If it was any other point in history, these people would be hung in public, and rightfully so.
@@breezyncj College loans and medical debt is treated differently by the government. It doesn't go away if you declare bankruptcy, and people can just show up and take your stuff.
Also, they can put a lien on things you own. For anyone who doesn't know, that's the government saying you can't sell your house or your car unless you pay your bills first. It's super messed up.
THANK YOU FOR THIS. ALL INSURANCE COMPANIES DO THIS. they will deny for things that aren’t even real. As someone who works in medical billing it’s so hard to get ppl to understand it’s not the hospital or the biller it’s the insurance companies refusing to payout
A friend of mine had his Cochlear implant surgery denied by insurance a couple years ago because his first doctor said it wouldn't help him, but his new one said there was no reason it wouldn't.
He got it on appeal, and has since gotten both sides done. He loves music, enjoys listening to his cats purr, and hates his neighbor's motorcycle.
The fear of having a large medical bill nearly killed me in 2017. I came back from a Disney vacation and suddenly got very very sick. I thought it was the flu or food poisoning so I figured I had to just ride it out. My boyfriend (now husband) kept asking if I wanted to go to the ER since I was so sick and couldn’t even hold down water. I kept telling him no because it would be super expensive (even with health insurance) to just get fluids and anti nausea meds and be sent home and then get a 1000 medical bill. After 5 days with zero improvement literally carried me to the car and took me to the ER. Turns out I had colitis and had severe dehydration to the point of nearly having a stroke (my blood pressure was SKY HIGH), I had a 103.9 fever, and my organs had begun to shut down due to the dehydration. I had also severe damage to my throat from throwing up so much and all the acid and bile in my throat. The triage nurse went sheet white when he saw my BP and immediately went to get the doc. Ended up in the ICU for three days and spent months recovering from the damage. Had I got to the ER right away the colitis would have been cleared up in about a week or so with meds (I didn’t know what I had was colitis until they told me and I had never had it before so I thought it was the flu) But I was so worried about such a big bill even with my insurance I kept telling my husband no I didn’t want to go to the hospital. Doc told me had I gone to bed that night I wouldn’t have woken up due to a massive stroke. My fever thinned my blood just long enough to get me to the ER. Had I survived the stroke it would have led to severe long lasting brain damage. Insurance people don’t care about their customers. They just want their money and because of it, they basically almost killed me. Even with insurance my hospital stay was nearly 3K. I absolutely HATE insurance and our stupid healthcare system. Unfortunately, it’s the only one we have at the moment and due to on going medical issues I am forced to use it. We truly need massive healthcare reform but I am not holding my breath. Both sides of the political aisle are too greedy and corrupt to ever make any real meaningful effort to change our current system. They would loose too much money.
My gosh that is a terrifying story. I'm so sorry you had to go through that.
I'm glad your husband was there, he sounds like a keeper.
It's stories like these that make me feel almost guilty about living in a country with public health services, although they are far from perfect, believe me.
Sending you love and hugs 🇦🇺
I almost lost my husband from delaying because of poor health insurance. He had a broken tooth and had to have a root canal back in March 2019. He had to pay $950 out of pocket for the root canal and was prescribed 800 mg of Ibuprofen twice a day. Little did we know that was the start of our lives changing forever. By May 2019 my husband was having some heart blood pressure issues and was taken high blood pressure medication small dose once a day and by June 18th he developed extreme hypertension in his lower exterminates and difficultly catching his breath. He setup an appointment to have an EKG done with his regular doctor later in the week but he knew something wasn’t right so on Monday afternoon he wanted me to take him to the ER after I got back from work has he felt he was going to pass out but knew he might not wake up from it. He was a retired EMS/firefighter so he knew what he was feeling wasn’t right. We even discussed how much this is going to set us back financially and was worried we could lose our house to medical debt. When we got to the ER his blood pressure bottom out and they had to give him medications to bring it back up. They did some tests and an ultrasound on his heart and we discovered he was in full blow congestive heart failure and had cardiomyopathy with an enlarge left chamber that was not pumping correctly causing him to have the hypertension and breathing problems. They decided to keep him overnight in the ICU and possibly transfer him to a major hospital but by that evening he went into cardiac shock and had to have a ventilator put in to stabilize him. He then was life star to a major hospital to have the ECMO put on him and 5 days later on June 25th he had a heart transplant! He was only 46 years old at the time, never smoked and haven’t drink in years. He was a work horse as a master electrician for 25 years and worked around the farm too. We were very very lucky to live in a blue state that had Medicaid for it’s residents HOWEVER we didn’t qualify at the time because we were just above their income cap and being self employed had little to no options for insurance. It took my husband to become permanently disabled to get the insurance coverage he needed. They fortunately back dated it to the beginning of the month when he had the heart transplant so everything from the moment he walked into the door of ER was covered but let me tell you the bills I saw from the experience shocked us. This whole experience cost over a million in 10 days time and that’s not including his life long medications costing thousands a month, tests and monitoring he faces. Again living in a blue state that helps the residents he has to stay here for the rest of his life in the network to survive. We both know that if he had this happened to him in a red state especially one that bans the Affordable Care Act he wouldn’t be live or forever in debt. This all could have been avoided if he had better dental care and better insurance coverage that would have brought him in sooner and possibly avoid the heart transplant. He’s doing Ok but basically he forever changed but glad he is still here with us especially for our young daughter.
To be fair the Republicans ideology is specifically to privatize, sure Democrats aren't great and they're corrupt as fuck, but nothing will change for the better under Republicans
Oof! That's awful, I'm so sorry you had to go through all that... I physically cannot even conceive of what that must be like to live somewhere that normalizes and allows for things like this, where people become accustomed to avoiding medical treatment at all costs, even WITH insurance, due to fear of the bills. I live in Canada and in Ontario no less, where our Premier (dude in charge of the province) is trying to actively change our system to a paid one like yours. It's absolutely disgusting and I pray that it never comes to pass and that we all, as a society, continue to vote against such things....
Unfortunately, there are a lot of VERY STUPID privileged people here who only care that the taxes are high because of the free healthcare and want "their money back in the pocket". Absolute nonsense, considering they'll just end up paying it all out AND THEN SOME the next time they get sick.
People here don't even consider NOT going, like you did. If we sneeze wrong, many of us will go in (or did pre-pandemic anyways), and most of us are reminded by stories like this that our system, flaws and all, is worth fighting tooth and nail for.
My sister will be moving to the USA soon to marry her beau. I'm scared for her, with all of her health problems... She already struggles to keep her health in order here, where she has access to many services and professionals free. What will she do there? Especially now her illnesses have caused her to have to stop working for a time. I mean, what good is having all the best doctors on this continent, if so few can actually afford it and most are avoiding going in until it's REQUIRED due to wanting to avoid bills?
I hope and pray things will improve for you all over there, and that one day you will all have basic health care needs met without fear of financial ruin as a result.
Every single working class and middle class person in America unfortunately knows someone in your position. Please do not take that as a slight against your horrible and despicable situation that you suffered through. My job pays almost 20,000.00 dollars a year, including my own payroll contributions and yet anyone who has a serious medical situation almost always has to choose between treatment and bankruptcy. The American dream is dead and never coming back, thanks to the absolute greed that is predatory capitalism. I am not advocating for Communism, but when you look at our near peer Western Democracies, we are literally the only country that is dealing with this issue. Its a travesty that I hope younger generations are extremely aware of and maybe in my lifetime will change. Your story rips at every fabric of decency in my body and I hope that everyone on both sides realizes how f**ked over we are by both sides of Congress being bought by big pharma and the insurance industry.
Please continue to explain healthcare scams to the public so we can fight back against these totally corrupt companies.
If only the public could do that on their own, imagine saying that in France😂
lol i'm too poor to afford insurance to begin with
it's almost like letting private oganizations take care of a countrie's health care system was a bad idea
Bad for the people maybe, but the people are not a factor in this system. It's good for corporate profits which is the only thing that matters at all.
@@wyntyrmute what was the point of this comment lmao
@@rey_8834 Pointing out that the system is working as intended. This is not a democracy and the ruling class gives zero fucks how cruel and miserable things are for us.
As a physical therapist, this is no surprise to me. Cigna and others deny for no reason and they will not tell us why. Leaving the bill to the patient. The patient is mad at us but it’s the insurance who is at fault.
Just over 3 years ago I had an allergic reaction to an antibiotic and it basically put me into immediate liver failure. In and out if the hospital for months, never ending tests etc. I was actively dying. I needed a live saving transplant but couldn't even be put on the transplant list until I had Medicare because I didn't have insurance. I called them almost daily begging them to look at my case and every time they'd say "we have up to 3 months to approve or deny you". I didn't even have 3 months left to LIVE and i was only 27 years old. If MULTIPLE doctors are telling me and insurance I absolutely need this or I'm going to die that should be the end of it. I should immediately be getting help. Not sitting and waiting on a fucking insurance company to decide to approve or even deny me if they feel like it. I ended up reaching out to my governor begging for help because I was just stuck and had no other option. It was that or just wait and keep slowly dying. Thankfully, he read my case and within 2 days I was in the top three on the transplant list because my case was that bad. About two weeks later I got my transplant. I got incredibly lucky. With absolutely no fucking help to the insurance. And I was 27 years old. Think about all the people my age and younger that are dying everyday just because insurance says "meh" and doesn't give the slightest fuck.
I used to work at a medical office for Sleep Apnea. Which can be deadly. And Cigna almost always refused to pay for it (a CPAP or BIPAP) even when their conditions were severe. So my advice for those patients was so switch coverage. But then they would have to pay for a sleep study all over again for the new coverage and that isn’t always covered fully. It’s such a broken and confusing system.
@@wendylea1983 that’s super common sadly. The home studies are convenient but not as accurate. You can have your doctor write that up. You can also submit your data from the chip in your machine as evidence of treatment and improvement because it should track how many apneas you have in a night. Your doctor should be able to access and print the report for you.
I hate insurance rules about sleep studies. When conducted according to the (very restrictive) rules, they are really only good at diagnosing sleep apnea or restless leg syndrome, and any of the many other sleep disorders can be missed in that one single miserable night. And then the insurance companies will use the “failed” sleep study to deny coverage for treatment. I have a circadian rhythm disorder and “failed” my sleep study and had to pay out of pocket for years, until a doctor convinced the insurance to accept actigraphy instead. Even now I can’t get treatment for the hypersomnia they suspect I also have without a sleep study.
I have long thought of insurance as little more than a scam. I do not understand why they are allowed to reject something a professional calls for or deems required.
Because it isn't illegal, and won't be as long as they're still capable of paying government officials to let them do whatever they want.
Because it is a scam and they've paid the government a lot of money to keep it that way.
They make literal billions by stealing money from citizens while fucking them over and not covering them for medically necessary tests, procedures, or diagnoses - the ONE thing they're supposed to do. With this money, they can line the pockets of politicians to increase their margins even further, or at the least keep the scam going for as long as possible.
I never got why there is anything other than universal healthcare. like end of the day we're all paying regardless, only with privatized healthcare there's a ton of useless middlemen like insurance companies taking most of the money.....
@@zwenkwiel816 Yea that part is what they try to hide from people who already have insurance they're okay or happy with. The fact that universal or not, they're still kind of paying for other people. When the insurance company doesn't have as much young people on it as it wants, it ups prices, when it's having to pay out for a bit more sick people than it likes, up goes the prices. When they just want to have a better quarter, time to pump those price numbers!
Insurance as a whole in this country is a complete and utter mess. My mother is an audiologist and just hearing her experiences with filing claims is enough to make me feel stressed. She’s been saying for years, they’re practicing medicine without a license.
I work in a hospital billing department and talking to insurance companies is like talking to a wall. I can't count the number of bills we've had to appeal and send back to insurance in the last week alone. What they deny is astounding!
My last job used Cigna to approve medical time off cases. It was an absolute nightmare to get anything approved and like you said, appealing anything was such an insane bunch of hoops to jump through. They weren't approving anything with long covid at all and a bunch of people lost their jobs because of it.
This doesn’t surprise me, I had this exact same issue with CIGNA. My doctor would have to battle them weekly to continue providing me with the treatment I needed to get better, because they didn’t think I was “sick enough” to be treated yet. I am 6’ tall, and should weight between 140 and 150 pounds, I was 100 pounds and my *kidneys* were shutting down, but yet CIGNA kept saying that I wasn’t sick enough to be treated…
That's scary 😨
Happened to me years ago! Took me forever to get into treatment. I was about the same size as you mentioned and they said I wasnt “sick enough “ either.
150 sounds underweight for 6' tall
As someone who grew up in Texas and didn't have insurance for most of my life because my parents were in that medicare gap, this is very concerning. I was only able to get insurance in the last few years because my job provided it. It makes me wish we could switch over to a universal type of healthcare. A company shouldn't have more power over personalized health treatments than you and your doctor, its crazy.
This is something that's very hard to explain to people here in Canada. Yes, you can have insurance, but there's no way to know if it will actually pay out. It doesn't work at all like the extended benefits in Canada.
I can't imagine paying 350$ for a blood test?! and my insurance not covering it? I go for routine blood tests every year for free, and if I had to pay for those as a broke student, would be insane.
@@kav4137 yea as a student…I just don’t go to the doctor. It’s not worth how expensive it is. I just suck it up when I’m sick.
Unfortunately, certain provinces run by certain parties are slowly moving to more privatized healthcare. We're not entirely immune.
Yup. Assurance and insurance are also two different things.
Blood tests are free. So are x-rays for broken arms as well as the cast and treatment. Canada's system is far from perfect, nor the best. But I just got home from 2 days in the ER and many tests later, I'm going to be just fine from a severe reaction to antibiotics. It cost me the price of parking.
OMG can you do more on this and expose them completely???? My roommate just has the most horrendous experience with Cigna, waiting 6+ months to get something approved (which only made her current state worse), and the only reason she got it approved was bec by some miracle we found a specialist who knew a back channel but like... otherwise ???
The coverage gap is heartbreaking. Trust me, I know... My heart goes out to those who have to deal with it.
oh boy, stories like these are the ones that hit deep inside and just make you go "is everyone just evil??" there really feels like there's no winning
Devil’s advocate here: it’s not that theyre “evil,” as if it’s something inherent to then, it’s that the system they live in encourages and rewards greed and abuse
America is a business, it's pretty clear it does not care for human life. All of the international community are terrifying careful to try not let this happen at home, America is still the wild west, except the robberies are white collar, and legal. Goodluck, you are going to need it.
Not everyone, just everyone in charge. Positions of power tend to attract evil people.
Not every one. Not even every company. But in America - it's easy to be evil and get away with it. So they do.
Everyone with morals leaves these kinds of jobs so there's a lot of turnover until an actual sociopath ends up in the role. So weirdly enough, these kinds of jobs are very good at finding extremely morally bankrupt people given enough time. As long as healthcare is run for profit, this end result is 100% guaranteed. So take some comfort in knowing that it's not that everyone is evil, it's just that the system is incredibly good at finding the most evil people and putting them in these positions. Good people are not outnumbered, but rather rigged against.
I remember working at a pharmacy and UnitedHealthcare was the worst offender of this. Routine psych meds would always be denied because a diagnosis code had to be used and only a specific med would be covered under a group. Nevermind that the med was available for decades and the other med covered doesn't work for the patient. We had a doctor call the insurance and he had to plead to them to give the ICD-10 number that worked and what could be prescribed. Then the issue may happen every month the patient needs a refill. Medicare also has a similar issue with ICD codes being needed for medication filled at the pharmacy.
ICD-10, CPT, and all the other medical billing related codes are a total mess.
100%! Cigna, I'm not surprised about at all. But I've found in my own experience billing for doctors that UHC tends to be far worse. They won't tell you anything, expect you to jump through hoops for payments that are minimal at best, and if you're not participating with them? Forget it. You're not getting a dime if you're not ready to fight.
I had UHC start denying my medication because my doctor didn't order the right amount that they liked. Then hey told me I could get my meds approved if I went to a pharmacy they partner with except that pharmacy chain doesn't exist in my town. So my meds are not medically necessary unless I go to a specific store to get them. I have to use coupons to get it now.
Wow. That’s eye opening. I used to work for a psychiatrist, in the late 90s, and I have to say at that time UHC was the worse insurance we worked with for the pretty much all the documentation we had to do for prescriptions. Also they required every three month primary care referrals, when we only saw our patients every three months… so unnecessary. We had to remind our UHC patients constantly to to not come unless they had their referral in their hand. Every other insurance company had annual referrals. I can’t imagine how hounded the staff in primary care doctors offices feel about all the paperwork to refer their patients with UHC to specialists.
I haven't finished watching the video to see if Phil mentions this, but the original Pro Publica article mentions that the guy who headed this project at Cigna did it at UHC first. 💀
I am so sick of insurance. The rising prices are going to be the death me.
That might be literally true.
Me with insurance but never have to pay for it 😍
@@Andrew110 good for you...
Advice as someone that used to work for Cigna, always, ALWAYS call in. Do not accept the denial outright. The contact centers will do whatever they can to approve your cases or to have your cases reconsidered/ appealed. Also, keep the contact center representative’s by getting names & any reference numbers they give you.
My boyfriend lost his medicaid in February because he "made too much." He made $9 an hour +tips (in Idaho) which varied a ton. It's still not enough to live off of. Thankfully, he got a new job that pays $15 an hour and has health benefits, but he has not been covered for a couple of months now and will have to wait until his work benefits kick in (60 days). This is definitely going to have some awful effects, and people will suffer without any insurance.
Yeah it's a scam you pay for something that you're not using and when you want to use it they deny you service.
My father has ALS, which is a crippling and awful condition, and Cigna denied his medication refill for a month because his doctor didn't say that it was improving his condition, just that he needed it. The problem is, medication for ALS doesn't 'improve your condition' it just delays the inevitable.
In that time he rapidly lost the ability to use his right hand and he will never regain full functionality of it again.
I'm not from the US but I can tell how important this information is for people and its wonderful that you're out here trying to help as many people as you can in the only way you can.
It's even worse for people who are pore. Even the affordable healthcare act (obamacare) you have to make at least 14k/year i make min wage in my state and they only give me 32hrs a week (not 40 so they don't have to give me benefits) i literally made 13k last year. so i don't qualify for the ACA i'd have to pay full price for insurance. I can't afford that, so I just basically "tough it out" any time i get sick or injured
That’s why it’s SO IMPORTANT to have certified medical coders!
Sending this to every Brit I know begging them to save the NHS so that we don't end up like this.
All this does is give people more reason to trust Crystal Mommies and Liver Kings to tell them how they should address their health. The American Health Care System is such a scam, I sincerely do not understand how this is allowed.
Because people just put up with it.
because the ones who make billions off of it have tricked the public into thinking single payer heathcare will leave them dead in the waiting room, when that happens under our current system,
Because the vocal minority who benefit from a super conservative and privatized system won't change it.
This literally just happened to me TWICE:
Last year I had a baby in June and the hospital decided to run a test when I got to the ER to see if my water had actually broke (bc me telling them it did wasn’t good enough?). Months later I received a letter saying that it wasn’t medically necessary and they were denying coverage. At that point I had already over paid so I was unable to appeal bc they say my “payment” as an agreement to their decision.
Then last week I found out they decided my dr visit from Feb was a specialist and I owed the dr the difference in copays. Apparently their AI decided that all Nurse Practitioners are specialists and all care provided by them should be billed as such. Still waiting on that appeal to go through.
I’m tired of Cigna (and all insurance BUSINESS for that matter) and I wish I could choose the best coverage option for me rather than my employer deciding to cheap out and give us crap
Insurance is crazy but disabled people trying to get on disability is even more.
A lot of older patients can not pay for anything anymore. It's sad
For real! I can't get on disability because they think I can work, but I can't and i have had 5 doctors write me letters. At this point my husband just try to plan our future around our impending bankruptcy. Or car is about to die but we are trying to wait until after we need to declare so that they can't take a car that works from us.
Edit:I have insurance and my husband doesn't make bad money. It's not great but if I wasn't so sick we would probably own our own house and such
This is a whole different issue because health insurance doesn't pay disability. Social security disability is a government program.
Even being on disability is fucked up. It is literally ment to keep you in the poverty population. The government checks your banks account every month to make sure you have no more than $2000 dollars in your account. You want to save for a house, car, service dog, customized electric wheelchair your fucked.
@@foxxxyg feel this so much. I am fortunate right now that I am supported by my family enough that I don’t have to get on disability right now. But it’s a crap shoot if I do get. Only about 25% of people with my disorder get it when they apply. I’m a little more hopeful because now there is an ICD- 10 code for it so hopefully we will be seen more
@@tiffbeevachou108 It's related because often the choice is attempting to get disability or attempting to find an insurance that wont charge you out the azz for said disabilities though.
As someone who had recently gone through vitamin D deficiency and had to get a blood test for it I went through the exact same thing. I was required to give out the documents leading to why it was necessary(Which I was told I could provide easily with the test results themselves) but due to everyone explaining "This is what you have to do" in their own way I ended up getting fucked over and had to pay out despite multiple attempts in appealing it. Being told multiple things from both the hospital and insurance company was fairly infuriating.
We had Cigna do this over many years and I had no idea it wasn't supposed to happen. My husband had cancer and they have continued to automatically deny him for almost every remission CT scan. They said the scans weren't "medically necessary" even though he had a nurse assigned to him and he used Cigna insurance through his entire cancer diagnosis and treatment. We ended up paying thousands of extra dollars that should have been paid by insurance just because we couldn't keep up with all of the denied claims due to the sheer amount of medical treatments he had to go through. He was also denied for a PET scan his doctor wanted to do, which would have allowed us to see his cancer wasn't all gone months before we found out through other symptoms. It delayed his treatment. I can't imagine someone trying to go through that alone if they didn't have a family member helping them with insurance. For years I have said these doctors denying claims shouldn't be able to deny a claim without seeing the patient. I truly believe it goes against their oath to deny a patient treatment ordered by another doctor without even seeing them. They should have to look a sick person in the eye and say they aren't going to cover treatment.
My sister and I have been denied surgery to fix our severe underbite because they said “we weren’t born with it” as if we were born like that. We had extensive documentation about our underbite from birth and going to the orthodontist for several years. They said it’s “a cosmetic surgery” when in reality it could greatly help our speech, eating, breathing, etc.
Have the same problem, the work around is getting diagnosed with sleep apnea as a result of the underbite. However, getting insurance to pay for the sleep study is almost impossible, and a sleep study is almost the cost of jaw surgery to fix the underbite, so you're kind of stuck. If course, if you go to your doctor about your trouble breathing and mention your concerns, they could help you out on getting a claim filed with your insurance.
@@vio_lin The surgery is seen as cosmetic at this point from the insurance since we have been fine, but in all honestly, it does affect my speech. Without insurance it will cost us 20k each which is far too expensive for any surgery and let alone for two people. We have tried braces, head gear, etc, to stop our jaws from growing too quickly, but they didn't work. The orthodontist also said we would have to wait until we were done growing to have the surgeries.
Philip! It’s episodes like this that reinforce that you are literally saving peoples lives. As someone with lifelong chronic health struggles in my late 20s, it warms my heart that someone with such a wide audience cares so much and is willing to put the effort in to help the masses. Although Canadian healthcare isn’t fantastic, at least I don’t have to deal with insurance anarchy. Love you dude! Keep rocking
I have worked in the healthcare industry, front office and IT, for a decade, from both the hospital, urgent care, and the insurance side, and what I have seen is just disgusting. I finally quit my corporate healthcare job recently because I just couldn't give my soul away to such a hurtful industry anymore. The American healthcare system is absolute bullshit and just wants us to die and leave medical bills to our families.
For anyone still in the healthcare system I am sending you love and gratitude that you continue to work to help patients in anyway you can. Just take care of yourself first and know when you time is up in the industry.
There's a great video by Evan Edinger that just compares the price of healthcare in the US to the cost of the same treatment on the NHS in the UK. It's no exaggeration to say that Americans are often paying between 10 and 100 times the actual cost of treatment.
I think the worst part is realizing it is from all sides in the industry too. l hated having to go to bat for insurance companies when I worked at one because I saw all the ways providers were taking advantage of patients. I also hated later realizing that some of that is a result of the messed up stuff insurance does. And the cycle continues. What makes it sadder is that the vast majority of people don't actually understand what's happening and a lot of it is a result of someone somewhere lazily forgetting or not caring that their choices are impacting real people. Now, I just warn people to be vigilant about their billing and EOBs, it's the only way to protect yourself. :(
I’m currently fighting with Cigna because they denied some of claims because they’re claiming my provider suddenly in network when they are. I will get a lawyer if I have to and file a complaint with the state.
I'm so happy to see someone cover this. My FMLA claim through my work insurance was denied and I struggled with is for months while I recovered. I appealed twice with no success. I eventually quit because I couldn't work for a company that wouldn't be willing to help me when I need it.
The exact thing happened to me last year! I was suddenly with NO INCOME while trying to recover and was almost evicted trying to keep my head above water - even though I just wanted to use the benefit I had already spent 3 years paying for? Had to come back to work early and spent the entire time applying to new jobs - I have my dream job now but that experience was traumatic. I’m so so so sorry for them doing that to you too.
This happened to me too. Was told later by my case manager that if I had mentioned I was prescribed a medicine my FMLA claim could have been approved. As if that's not my medical provider's job to include all the details of my case....
Something about being told after the fact what I could have done to make approval more likely really stung. Like wow, if I knew this not 3 weeks earlier I might still have my job, thanks so much
FMLA is such a huge pain in the ass, I swear that my Dr's office fucks up their side of paperwork every single time; not only that Lincoln gives me such bullshit excuses, yanking me around. It just took me almost 50 days to extend my intermittent FMLA with them both, fml.
@@herefortheshrimp1469 i used to work for insurance companies for like 15 years… not only was the work boring as shit. But not a single person cared about the customer one bit. All everyone cared about was ensuring everyone paid their premiums, and how we can get more healthy people to sign up for insurance. The only time something “positive” was said was when the execs would tell us a story of a customer who got paid… acting like a handful of people getting paid was a good thing.. if you need insurance you cant get it because you need it… if you dont need it the insurers are ready and happy to cover you. I always said insurance is a fucking scam for 9/10 people. I literally work in a call centre now doing collections… but the company cares about the customers we have tons of options to help the customer not obliterate their credit. The company cares about its employees and i feel valued and i feel like even tho my job is to collect, i have the ability to help people with their payments and it feels like at least i can help. I will never work for insurance ever again lol fuck that shit, let these greedy fucks get their robots to do all their work. (The old job i had also got rid of all their customer service team and sent it all out to india, because they can pay someone there 1$ a day vs 15$/hour in canada. I have zero respect for insurance companies.
All of these doctors should lose their licenses and be barred from practicing medicine of any level in all 50 states.
Often the doctors employed to review medical claims are retired anyway so it's no skin off their teeth
They aren't working in a clinical situation, so nothing will happen to their licenses.
in my country you does not need MD..just degeree in medical line..
That explains why my mom’s necessary back surgery was deemed “elective” . She was in pain for longer than she needed to be. I’m so pissed!
My husband’s jaw surgery was partially covered because without it he’d eventually develop arthritis but the adult braces he needed to qualify for/get the surgery were deemed ‘cosmetic’ and insurance refused to cover it 😡
When I started working full-time in 2013 I got my own insurance for the first time. They denied EVERYTHING for the first year, usually as a pre-existing condition. I just believed them because I didn’t know any better. Then I got a piece of wood in my eye and had to go to the urgent care to get it removed. That was ALSO denied as a pre-existing condition. When that happened I finally called because I knew the eye injury wasn’t pre-existing and they basically told me “yeah, we deny everything for new customers because we have no records and don’t know what’s pre-existing or not.”
United is doing a similar thing! They have denied one of my routine ultrasounds several times...all because my doctors office "didn't get preapproval" so they deemed the procedure "medically unnecessary." So even though its normal to get an ultrasound at 32 weeks to check the size and postion of the baby to help prepare for the delivery, they won't cover it because no one asked them first 🤦♀️
My favorite part of this scam is that the providers' contracts with these scumbag companies say that coverage decisions can "in no way" be considered as influencing medical decision-making and treatment decisions. It's such horseshit. I used to work at a billing company serving small doctor offices and it used to feel like we were helping them, but the endless wild goose chases to get claims paid got so ridiculous that I burned out hard and had to leave the field.
This was the story of my life for years while fighting with Cigna to get neck surgery that I desperately needed. At every. Single. Turn. we would end up with a rejection letter from Cigna showing up in our mailbox. The doctors weren’t even surprised when we told them, they just knew to automatically appeal on our behalf. Sometimes we had to appeal FIVE TIMES to finally get something covered. It’s crazy to me because Cigna is considered one of the good insurance companies too, but they’re doing stuff like this to countless people…
Sad thing is, it probably is "one of the good ones." That's how low the bar is set in this country. It's utterly disgusting.
There’s no such thing as a “good” insurance company… Crap like this is the least they do to people.
I’ve been screaming about insurance since I first started working in the hospital. I can’t tell you how many people I had to send home without what they need. I’m so tired of fighting every step in the system.
I was initially denied for my cesarean, which was done under emergency circumstances. The insurance company claimed it was not medically necessary, but the doctor who made the decision stated that I would have died in childbirth if they had not done the emergency cesarean (without going into too many details). My husband actually accused the insurance company of preferring to orphan three children rather than take care of their mother. It took almost two years to finally get our claim approved, and really only after our lawyer basically accused the company of the same thing my husband had.
Got Cigna through my job 6 months ago. I've been fighting with them for those 6months to get them to cover my asthma medication.
They initially told me they denied my claim because it wasn't pre approved, even though the medication is part of their formulary AND I'd been seeing a doctor for it since 2016. Then they made me and my doctor do the jog of here is all of these other medications that don't work for you but we need you to try anyway. Fun fact: they tried to block my ability to pick up/cover the cost for those medications as well. Now they just hang up on me when I call to reappeal their new denial for the medication that works for me. When I finally do get a person on the phone I'm told "your doctor needs to send in a pre approval". We've sent in 4-5 at this point, where did the last 4 go?
My doctor and I are both sick of Cigna but there's no other choice as it's employer health insurance. A lot of my coworkers have similar issues and have had to supplement their insurance with state insurance to cover their healthcare. Cigna is by far the WORST insurance I've ever had to deal with and in the future when applying to jobs I'll do my best to avoid any company using Cigna.
The only solution to this is to have Universal Healthcare. Every other developed nation has this but us
yea but in places like Alberta Canada specifically we're becoming ameribrained and our governments actively stripping our healthcare funding ramping up for privatization
that's socialism! /sarcasm
This. Why is America, the richest single nation in the world, not caring for their people with free healthcare?
Greed. That's why. Eat the rich.
What if we just made gofundme a nationally subsidized platform and called it “universal gofundme” and just had everyone pay a percentage of their income into it and.. oh. Wait a minute.
@@bigandhairyrichard6333 that's not a Free Healthcare issue, that's a leadership issue. Free Healthcare works, but it needs to be funded.
New provincial elections are coming up for Alberta. Time to vote out the Cons.
This is wild. I have Cigna. I’m supposed to be going in for surgery within a couple of months. The Cigna rep I spoke to said that my surgery was covered by insurance. I hope that they don’t deny my shit once I go in. Thanks to this I’m going to fight the case if they decide to fuck around.
Hi Alexis! I work in healthcare and deal with insurance providers all the time. PLEASE contact them back and ask them to send you a letter with WRITTEN APPROVAL so you're 1000% covered later down the line closer to your surgery date. Don't take what a random rep says over the phone as gospel, not every call has recorded notes and that can give them room to simply state it was never approved in the first place
Exactly what Lauri B said. I’ve even got the reps name and employee number before and it didn’t do anything for me. Get it in writing!!!
☝️yep - and even then, prepare yourself to fight it. I had written approval for a breast reduction and my surgeon called my two weeks after to let me know insurance decided to only pay about $2000 of a $12,000 surgery - and that was after my own $4000 deductible. Fun.
@@lady2sakura2006 thank you! I’ll call them back to get the written approval.
Fr gang I'm so happy to know that I will appeal every denial these fucks send me.
So glad Philip is spreading awareness about this scam, its mind boggling how shady people can be
I know, just look at everything you had to go thru just to cover cancer treatment!
The ONLY positive thing the broken system did was provide a logical premise for Breaking Bad. Which is more messed up than anything that happened in that show.
I purchased an injectable medication for my wife about two weeks. I asked what my copay would be and was told it would be $25. Yesterday I received a letter informing me that I was under billed for the drug and that I now owe them for my wife $321.91. The pharmacy ran the drug through the Cigna computer, as is always the case and their computer or contracted computer tells the pharmacist what the copay will be. I relied on this figure given to me before purchasing. So if this amount is paid this one drug will account for 15% of her monthly social security check. We have other drugs that she can not do without! So this means any Cigna member can go to the pharmacy pay a $20 or whatever copay and two weeks get a letter,” we undercharged you, you owe us $1000! I am a retired pharmacist and have never heard of this happening. We have personally had Medicare d for several years and this never happened with the United Healthcare (aarp) plan or the WellCare plan!!
I work with a third party benefits administrator and oh my god the Cigna story explains SO MUCH. We’re dealing with so SO many denied Cigna claims and now we know why!
If you get your claim denied, CALL YOUR INSURANCE AND PROVIDER IMMEDIATELY
My husband started working for a company that used Cigna for health insurance. A few months later, he was on a trip (personal) and he was injured (oil burn while cooking), resulting in a trip to the ER. He used insurance and about a month after the incident, he got a letter from Cigna asking if it was a "workplace injury" and talking about how he would need to go through his employer if that's what it was, and that if he didn't contact them, they would assume that it was a workplace injury. We were like, WTF? He was nearly 400 miles from home, on a vacation, and burned his hand while cooking over a campfire. But Cigna was going to assume it was a workplace injury unless he called them?
We have never before experienced an insurance company behaving like that. It was nuts.
This may be an expose on Cigna but they’re not the only ones who do this! I have heard so much behind the scenes of this happening at Aetna, AIG, etc. insurance companies thrive on a denial culture but the employees are not allowed to admit it!
Aetna was exposed doing the exact same thing a few years ago. It's all a scam.
I used to do medical billing… They’re ALL like this or worse.
Absolutely. Before prescribing any medication that isn't generic, and even after checking the formulary for an insurance company, you can't always guarantee that it will be covered. All of your doctors offices have at least one person on staff who spends most of the day making phone calls and faxing letters and other forms of jumping through hoops to try to get even basic stuff covered for you.
And when the medication needed is something that costs tens of thousands of dollars per month, like the newfangled "biologic drugs" and what not, it's automatic, that it won't be covered and it will take weeks to months to get approval, if ever.
There would still be a certain level of this if we had universal healthcare, obviously, but there wouldn't be 20 different sets of rules
blue cross blue shield of alabama literally destroyed my psyche for a period in time 😭 i went through hell with them, i have no insurance right now & im dealing with less bullshit than when i had bcbs and cigna
@@bri6032 -- BCBS can be tricky, because some versions in some states are nonprofit, and other versions in other states are for-profit. Definitely the nonprofit versions are better, but even they will give you the runaround with prior authorizations and things.
Been fighting with my insurance to cover my diabetes equipment and WHY IS THIS COUNTRY SUCH A NIGHTMARE
Because money breeds greed, which breeds lose of basic human care. United States of America. Nahh United States of greed more like it
What equipment are they denying you? Just curious because my son is diabetic.
Until states start enforcing rules against these companies nothing will change. Washington state for instance mandates that insulin and diabetic supplies cost a maximum amount. Insulin is at a $35 copay for 30 days.
@@WitchPsy2 Same here in California. I thought that was true across the country now?
@@naturalvee67 Only a couple states legislate it and its a travesty they dont.
I really appreciate the single big issue videos because it makes it easier to share. Please keep this up!
This is why I'm shocked it took this long for someone to take revenge on a health insurance CEO.
I had Cigna for a very short time last year through a previous employer and experienced the same issue with them denying my mandatory medical needs and had to pay out of pocket. I abandoned ship so fast and am happily with BCBS now. Well, as happy as you can be with any major health insurance provider.
As an insurance agent who deals specifically in Medicare Advantage for the last two years, I’m not surprised at all. I am one of the top Medicare insurance agents in the country (based on personal enrollment numbers) and have worked with the largest broker GoHealth as well as other major brokers of Medicare Advantage. I have sold for Cigna, Aetna, Wellcare, Humana, UHC, Kaiser, Molina, and others. The amount of fraud and scams that agents do to convince people to join insurances is insane. Lying about coverage amounts, copay’s, deductibles, etc. and then the insurance company is screwing them on the back end. It’s insane. Sad to learn that these people are getting double screwed.
Lol I knew it. I had Cigna the last 18 months. $600/month to cover my family and I desperately need a couple medications but it took months of appeals and eventually me just giving up and saying I’d pay out of pocket. So I’ve been paying $600/month + $150/month for medications (thanks GoodRx! It would have been another $400 even generic) and another $160/month for therapy. I actually pay $600/month for them to cover essentially nothing and our family deductible is $4000 and unless there’s an accident, we won’t meet that.
Edit: also why are states kicking people off? Do they realize they could just… not? We make up all these lame ass rule and they choose to hurt instead of help. They hate you.
As a hospital social worker: I am always enraged by insurance. Our PT and OT department has to be careful how they document or it will disqualify patients from care
My former job required me to fight Cigna to pay claims, we didn’t push denied claims to patients we would fight for years to get claims to pay. It was so exhausting
I had Cigna for dental and I dropped them after they kept not auto-renewing my enrollment every couple of years, forcing me to re-enroll and resetting those damned "waiting periods" for procedures. That caused me to have to pay out-of-pocket for everything from basic cleanings to routine exams because their waiting periods requirement hadn't been met, despite the fact I'd had their insurance for several years. After the last time this happened I dropped them and switched to Delta Dental. So far they've treated me much better.
I work in healthcare management and I’ve experienced so many claims and appeals being denied. Something I’ve heard from reps that they automatically deny first claims to force people to submit a second appeal which is the last type of appeal. There have been so many claims that get automatically denied due to a diagnosis and procedure code being supposedly unrelated, even for preventive visits!!!
Thank you for covering this topic. I work in billing and coding and I have seen and experienced some of these insurance problems and it kills me that people don't know to appeal. Call and ask which MD made the denial. If the Insurance company can't prove that an actual MD made the denial and you argue that it's practicing without a license they will, 8 times out of 10, turn around and approve the procedure. It's horrible and so many die from the way that insurance companies in the US handle these claims.
We have to move to national single-payer 'medicare for all' model. It's more cost-effective (appr. 2-3x moreso) and it results in better outcomes (barring a few niche treatment areas). Set aside ideology and just think about the economics & the moral value in a preventive care model. The USA model is profit-from-suffering model and especially since wages, adjusted for inflation have no risen for more than 50 years, it's unsustainable as is. The entire 'free market' nonsense doesn't apply to healthcare and it never can. Our HC cannot be assessed via traditional supply/demand interactions. If we look at just three things in the USA. a) rising costs of HC b) rising costs of education and c) rising entry level home prices. ...a simple review of those things in relation to wage-n-income makes crystal clear we cannot continue the trajectory we are on and all this right vs left tribalism is simply a tool to keep us divided while corporations exploit us every single day in this country. Don't believe me? just ask those bankrupted by HC bills (even those with good insurance)...since HC is BY FAR the #1 reason for bankruptcy in the USA. Sure, there are things we can disagree on ideologically but health care does not have to be one of those things - quit drinking the lies told to you by politicians and those who profit from suffering.
im in canada and applying for disability. my lawyer, who is helping me appeal the denial i received after waiting over 145 business days for an initial decision, told me 90 percent of applications are applied even if you have a strong case because most people give up and dont appeal. he also said the request for internal review which is the first step after a denial is usually denied as well and have to go to the social benefits tribunal where i could be waiting another 8 to 14 months from today.
Wise move releasing this on the weekend so as not to demonitize the week day shows. Edit: Loving the deep dives into news that affects me instead of the famous people shenanigans we get sometimes.
EXACTLY! I'm so tired of hearing about dumb internet drama no one cares about. Tell me how my government is screwing me so we can get angry enough to attempt to change it.
@@AssGasGottaBlast Strike my guy its the thing uncle sam hates more than anything. It got us saturdays off.
As a Canadian, this concept is extremely alien to me. It feels wrong. It feels like a crime... I truly, truly feel for you Americans. :(
As a Canadian I also feel like it was wrong that my classmate from uni’s sister under 20 had to wait 7 month to get treatment for cancer. Now that’s completely unheard of in the USA
@@spritedrin No it isn't. It's quite common actually depending on what part of the process you are talking about. Wait times to see any kind of specialist is very similar in Canada and the us. I know, I have family in both the us and Canada in multiple provinces and states. Obviously there was issues with the pandemic that changed things but that's got nothing to do with the effectiveness of either system.
I know you think that US hospitals have 500 teams of doctors and nurses with an entire army of staff just waiting at the door for a patient to arrive and nobody ever waits for treatment but that's totally false. In both Canada and the USA the treatment available and the wait times to see a specialist or if there is a specialist available varies widely depending on the area and the population density of the area.
@@spritedrin it is extremely common here in the US, stop listening to conservative propaganda, they are trying to get rid of your health system for profit. I recently had to wait 6 months to see a neurologist, and because I don't have insurance most doctors won't even see me.
@@joer8854 I live in the Us and work in the hospital and experienced both Us and Canada . Everyone’s experience is different but Canada isn’t as good as most thing it is
@@MikePerreman idk where you are getting 70k from. My husband has 2 emergency surgeries back to back for 2 years and max we spent was $7k the first time bc he bought the cheapest insurance and $1200 the second time because we bought better insurance
Hmm. I bet that’s why I’ve had a rejection due to “unnecessary testing”, despite having a referral, testing, then needed a referral from someone else, who then said they wouldn’t refer me because that’s my psychiatrist’s power, mind you, my psychiatrist being the original referrer, and the insurance claiming to cover testing
Luckily me and the neurosurgeon are fighting to repeal, because there’s no logical reason the test cost would not be covered
Imagine those working in healthcare insurance billing compliance like myself that have written reports and audits for years for things just like this. Where do the audits go? I've been in the medical field since the 90s.
HHS (health n human services) and CMS (Medicare) can be contacted as well and fraud reported right on their websites.
Issue is far too many people call the insurance company, the very entity that is causing their issue in cases like this.
Thanks for including the story that covered my fight and highlighting this issue
I used to work for Cigna through a third party call centre, I was once suspended for sending a "strongly worded" email to a claims processor whose biggest gripe was that it included the word nonsense because they kept sending at members check to the wrong address, I was suspended for 3 days
as someone with chronic heart problems dealing with the medial systems can really destroy your self esteem but i want to tell everyone to remember to keep pushing for what you need! awesome of Phil to tell people to appeal these claims cuz they are counting on you not. this is so incredibly true. the squeaky wheel really does get the grease in this industry.
You have no idea how much I appreciate the daily shows. It keeps me off the social media doom scroll and it’s something I really look forward to that it becomes part of my routine. Probably intentional from Phil and his team, and I’m sooooo grateful ❤️
Regarding the Cigna segment- as someone who works for an insurance company similar to Cigna, though not specifically in the claim department, I can confirm there is more than 5% for appeals, but not enough. My company is usually pretty good at catching issues with the algorithm, but still runs on a 20 year old system for claims processing…
They need to be held accountable for this, AND fix it, because being told an algorithm handles the claims is....beyond asinine.
I'm so tired of people thinking it's SO EASY to even just update your address with Medicaid. If you're on Disability, you have to go through the SSA to get that changed which means waiting for hours in an office or on the phone. Every single time I have tried to call to update my address in the last year I have been unable to get to a real human person who can update it. All of the Social Security offices within 30 miles of my location were closed during the pandemic so I can't just go in person either. This system is so much more broken than you even realize. You can change any information you want online with social security... except your address.
My daughter was insured under her step mom.... Cigna and my insurance BCBS. She owes 9k now and every week it goes up with back claims finally being processed. She's 19. She just wants to not want to feel like she wants to end her life. And this is how she gets the help, sorry you owe us 6k we can't help you aka they're just telling her to off herself. She found a new doctor and same thing, after a few weeks they couldn't give her meds or see her anymore because insurance wouldn't cover. Now she's in medicated with a bipolar, ptsd and I forgot the exact word for it but a multiple personality disorder of some sort at 19yrs old. She can't work, she can't get a diagnosis for meds ans now she owes 9k and I have to worry about elher every single day. Eff the medical system!!!!
Please have her work something out with the doctors. Sometimes they are open to helping people out. 😢
I am going through the same with my 19 yr old, but in Canada.
Insurance company executives and shareholders are profiting while people are dying. They should be in prison.
Ever watch one of those movies where a local gang or mafia "offers protection" to neighbourhood stores? The main difference between those thugs and modern day insurance is that the thugs have some motivation to keep the local economy running, and accountability has real life consequences.
Insurance is basically legalized theft.
I used chatgpt to write denial appeals when my mother was dying and it still wasn't fast enough. she never got the treatment she needed.
My dr: here’s a script for a new med for your debilitating migraines.
Insurance: nope. Try those other meds(again)
Dr: here’s a script for those “other” meds
Insurance: also no.
Me and dr: 🤯🤯🤯🤯
Thank you for covering this!!! I’m so tired of paying nearly $10k a yr for my family and STILL needing to depend on manufacturers “assistance programs” to get meds I need esp for my mental health. It’s a sham, y’all! All a sham! They ALL bank on you not appealing. Appeal them all!