Health insurance is kind of needed nowadays. Putting aside the fact that if given the chance, most hospitals will nickel-and-dime patients because they are businesses first, medical procedures can be extremely expensive by virtue of requiring lots of little to big things. The doctors need to be paid, the equipment needs to be maintained, some of said equipment is one time use only. It’s expensive for people, so insurance is there to help take a chunk of the amount owed. But there is a chance that the insurance company will deny any applications for medical procedures, including simple ones like blood works or the like. It does happen and it is terrible when it does.

This is where Cigna comes in. Cigna is one of the largest insurance companies in the country. They insure millions of people and issue both Medicare and Medicaid products. And they are also one of the most hated companies in the country.

Cigna is currently embroiled in a fraud lawsuit that was filed by the Department of Justice and it is also trying to handle an article from ProPublica on how the company saves millions because their doctors will deny applications without even looking at the file. The filing happened a couple months ago back in October while the ProPublica report was released on March 25. 

Nick van Terheyden was denied by the company to cover a $350 blood test, because it was not “medically necessary”. The man in question was suffering from a vitamin D deficiency in his blood and his body was siphoning calcium from his bones to make up for it. If it was left untreated, the man would have developed osteoporosis.

After some digging and talking with former workers, it was revealed that Cigna uses a program to flag files if they have certain keywords so that their doctors can mass reject cases and save the company millions. None of the cases are gone over to see if the company actually has to cover them or not. According to those who were interviewed, it can take as little as 10 seconds to reject a large batch. 

The other story mentioned is the fraud lawsuit. It was revealed by a Whistleblower that Cigna was defrauding the government by sending in more codes then what they were supposed to in order to inflate their numbers and gain more money from those using its Medicare Advantage Plan. The complaint was issued in New York, then it moved to Middle Tennessee, and was eventually picked up buy the DOJ.

Here is the full article to gain more information.

And here is the filing if that is more interesting.