Health Insurer Greed or Desperation? An Odd Data Point From Cigna

I sometimes give personal Consumerist-type anecdotes about dodgy vendor behavior in case readers have had similar experiences.

Admittedly, health insurers being difficult about paying claims is so common that they fall in the realm of “dog bites man” stories. But the elements of my latest arm-wrestle with Cigna suggest that the insurer is so eager to maximize profit and burnish its financials that it is doing the equivalent of pulling up the sofa cushions to collect change.

I’ve had this plan a very long time, since the early 1990s. Cigna in theory has not changed the terms (to do so, it would have to notify me and New York State) save approved rate increases. In practice it has, by among other things a few years back requiring that claims be submitted within 120 days of service. That has allowed it to engage in a new form of mischief: simply not processing some claims. No doubt the hope is that consumers won’t notice, or will notice too late to get duplicate documentation and resubmit before the 120 days are up.

Mind you, for well over 15 years, I never had a single claim go astray. Now it happens with sufficiently high frequency for it to be implausible that the US Postal Service is losing so many of my letters, when other envelopes virtually never go missing. So every time I submit a claim, I have taken to recording the details necessary to locate the items in Cigna’s system, as well as the mailing date.

Last July, Cigna sent a letter about a “pharmacy claim”. It was a remarkably content-free document, with no reference to dates of service or any clues to allow a customer to figure out what they might be referring to, particularly since I do not have a pharmacy plan. A “pharmacy plan” is when the doctor sends a scrip to the pharmacy on behalf of a patient, and the pharmacy bills the insurer, with the patient responsible for any co-pay. My plan covers prescription drugs, including ones I get overseas (I’ve submitted prescription drug claims from England and Australia). I pay for the drugs and I submit for reimbursement. And until the mysterious July letter, I never had any problem with them being paid (provided, of course, Cigna didn’t try claiming it had never gotten the claim).

Fortunately, because I keep good records, I could see I had sent in a claim in late June for four dates of service for less than $400 worth of meds total. The only reason the amount was that high was three of the four items were 90 day supplies.

I called Cigna and got a rep who found the four items and confirmed they were in a payment limbo and ought to be paid.

When no check had arrived by September, I called again, had the agent say that there was not reason for the claim not to have been paid, and put it in for reprocessing.

On November 28, with still no payment, I insisted on speaking to a supervisor, which it took an ungodly amount of time to reach. I started making noise about external appeal to New York state (my plan is a New York state regulated plan). She confirmed like everyone else that it should have been paid, and said the check would go out in three to five days.

Two weeks later, nothing from Cigna.

I called again. I got an agent who said the payment is pending.

By this time, steam was pouring out of my ears. I asked again to speak to a supervisor. After a 30 minute wait, I was told one would call me back. I should have known from long experience with Cigna that promises to make calls or follow up are empty, as this proved to be.

I decided to have one last go on the phone before writing the state for an external appeal. I called over the weekend. The agent said that the payment was issued on January 3, but she saw only three of the four drugs in the scans of the claims. Mind you, this was the cheapest scrip, and a shortfall versus what I should have received of about $13 (assuming that check finally arrives). But this is what this incident says about Cigna:

1. Recall that on the first call, and if my recollection serves me right, on at least one of the later calls, I confirmed the dates of the claims. The one that disappeared was the most recent in the date range, making it almost certain that I cited it most if not all calls.

This strongly suggests that the original Cigna hope was that I would not follow up adequately on their bafflegab letter, and when I did, someone went and scrubbed my record to reduce the amount Cigna would have to lay out. This is such a small amount that it would seem hardly worth the effort….which further suggests that Cigna has this sort of records-doctoring highly enough routinized to be able to do it cheaply.1

2. Cigna has supposedly initiated payment right after the new year. Even though Cigna ought to be on an accrual as opposed to a cash accounting basis, it’s not hard to infer that they kicked the payment back into a new fiscal year to flatter some sort of metric. It might not even be a financial reporting metric but some other measure that senior management and/or analysts follow.

As we said at the outset, in terms of abuses, this is small beer. But that’s the point. Corporate America has been institutionalizing penny-ante scams like the one Cigna ran on me, knowing in this era when class action suits are virtually dead, that they can grift with no fear of being held to account.

The punditocracy wonders why more Americans aren’t worked up about Trump’s misdeeds. The great unwashed public is beset with abuses much closer to home.

____

1 The last agent checked my records for the date of the gone-missing drug claim to see if it had somehow gotten separated from the other three and was being handled separately. She came up empty-handed. Recall that I now have a not-approved, not-noticed-as-required change to my contract of a 120 day submission limit, so disappearing that item so late in the game makes it impossible for me to resubmit that item.

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81 comments

  1. Geo

    The punditocracy wonders why more Americans aren’t worked up about Trump’s misdeeds. The great unwashed public is beset with abuses much closer to home.

    Well said. You’re much more thorough and persistent than I am. I’m their target dupe that won’t notice such things and just accept that it was my fault when I do notice. Very insightful read. Thanks so much!

    Reply
    1. WestcoastDeplorable

      Sorry to read of your problems, but Insurance companies aren’t the only category screwing with the details; I recently transferred a balance to U.S. Bank on one of those “zero interest for 12 month” deals. In about 2 months after the transfer, all the sudden I get a late notice from them, then realize I didn’t receive a statement (which was about 10 days late). And they laid a $39 charge on the account, which I was able to get waived with a trip to my local bank. Little did I realize this “late pay” also resulted in nixing the “zero interest” deal, and they levied the full interest on the balance.
      Needless to say, I transferred the balance elsewhere, but seems to me lots of companies are gaming the mailing of statements to pad their coffers.

      Reply
      1. campbeln

        I had a good one with Macy’s… we bought a ton of stuff for the new house back here in the US and got the 0% interest for 12 months on their credit card for the first purchase or some-such. What the lady at the counter did was to run 2 separate transactions on the card so the second, much smaller, transaction fell outside of the “first purchase” and incurred the minimum monthly interest charge. Over the course of the 12 months, I’d have been in a slight deficit thanks to these additional charges, so I paid the damned thing off in full and threw it in the drawer.

        So… Macy’s went from having a part-time AmEx card user to one that never uses it all because they didn’t want to uphold their own promo… Picking up pennies in front of a steamroller…

        Reply
      2. Barbara

        Some years ago, I got such a 0% offer from a bank which issued one of my credit cards. This one was for existing debt and lasted until the debt was paid off. I was happily paying off my debt in reasonable monthly installments. After I paid my 6th monthly installment, I got a letter from the bank saying that they needed to raise the interest rate and would appreciate if I would concede. They added that if I continued to insist on 0%, as was my right to do, my credit card would be discontinued on the last payment. I chose to continue the 0% deal and, as promised (the only promise they kept), my credit card was cancelled thereafter.

        Fast forward several years, I regularly get credit card offers from said company. Needless to say, I don’t think much of people (or businesses – corporations are people too!) who renege on deals. You can guess what is not in my wallet!

        Reply
  2. The Rev Kev

    Excuse for for asking but just to clarify a point. When you send mail to Cigna and you say that you record the details, are you talking about certified mail and registered mail then? The reason that I ask is that by using the same in Oz, it has saved both my daughter and I individually over a thousand dollars each when the recipient tried at first tried to deny receiving what we sent until confronted with tracking numbers that can be checked online.

    Reply
    1. Arthur Dent

      More and more I am going to tracking numbers with signature required for things that have any sort of value.

      The joy of focusing on shareholder value is that all other stakeholders are subservient to it. Ultimately, the sheer greed of the corporations is likely to force the general population to demand a government-run single-payer system where at least they can vote the politicians out of office instead of having unaccountable executives making their lives miserable. The inability to repeal the Affordable Care Act was just the first shot across the bow.

      Spent more time in Canada over the past few weeks. Everybody I spoke to up there is utterly baffled by what is going on in the US and is seriously wondering if the US is officially insane. They cannot understand why we continue to live down here. BTW – many of these people are white people over 50 with military backgrounds and little to no college in the demographic that would have been probably voting for Trump in the US.

      Reply
    2. Yves Smith Post author

      It takes $3+ per envelope to send something certified and a half hour tax on my time to go to the post office.

      And sending a letter certified does not prove what was in the letter. It’s useless from an evidentiary standpoint. Cigna could claim the envelope had no claims in it, or that the claims were “unscannable” (another “dog ate my homework” they’ve tried now and again). It’s useless in proving a submission.

      Reply
      1. monday1929

        Yves, you might try video-taping the mailing process, including video showing the papers as legible etc as they are sealed in envelope and handed over postal counter and showing tracking numbers.
        Include in the envelope a letter explaining you will post video on you-tube if they claim “unscannable” or that envelope was empty.
        United Healthcare broke dozens of promises to “call back”- they never ONCE did so. Hopefully not to far off topic, I would like to keep NC updated on current complaint with NY Office of Professional Discipline regarding a dentist who possibly hid about 100 bad (as in semi-criminal) Yelp reviews by establishing a phony company name and shifting reviews there. So far, after one month not a peep from Port Chester regional office where referred to.

        Reply
        1. beth

          Alert to United Healthcare Medicare Supp. retirees. I’m sure the UH did this not just to me but to all of those who carelessly pay all bills sent to them. When I signed up for AARP United Healthcare insurance, the rep told me that he would have to accept a check for the first month and then had to put me on a ckg acct withdrawal plan. I had never done that before and didn’t like the idea. It turned out that that saved me in the long run for two reasons. First they billed me for the first month after accepting my check. I did not pay it and by the time I received it they had already taken money out for the second month. I am sure there are many seniors who just paid the bill anyway. Slick trick & sick trick.
          And then a year later I was finally diagnosed with my genetic disease after all these years. I began getting the only medicine specifically for this disease which since it is an orphan drug is expensive. They rejected the first bill from the provider and told them I was not a member of the plan. I was thrilled that I had had the money taken out of my acct. so they could not say the check was late.

          Reply
  3. vlade

    Hmm.. I haven’t seen “the cheque will be issued” excuse for ages now, courtesy of pretty much all European payments being direct and settled on T+1 latest.

    I guess having netflix and Facebook (the “great innovations” coming out of the US) is more important to a number of US residents than a working payments system like say the EU has.

    Reply
    1. mle detroit

      I’ve been trying unsuccessfully to decode your first sentence. What is this payments system, where can a neophyte learn about it, does the UK use it, and what how Brexit affect it?

      Reply
  4. Disturbed Voter

    Stick to your guns, and make them meet your business performance metrics!

    Heath insurance is inherently un-profitable in the long run, unless service is denied.

    Reply
  5. Louis Fyne

    cigna bought express scripts and the deal closed in december.

    it could be cost-cutting-induced incompetence. it could be intentional revenue padding. could be both.

    and ya, compared to the daily/weekly neoliberal microaggressions, no wonder why after 3weeks a lot of people shrug when it comes to the government shutdown

    Reply
    1. rd

      This government shutdown is going to get very interesting as the Trump Administration tries to expand what are “essential services” requiring workers to come in without pay. So far it hasn’t interfered with my travels because the TSA and ATC workers are all there working without pay. I believe tax refunds are going to be declared “essential” so those workers will be called back to process them without pay. This will likely be occurring in numerous other areas as the Administration gradually discovers that government workers actually do something.

      Thad Allen had an interesting interview on NPR this morning as he discussed the Coast Guard working without pay: https://www.npr.org/2019/01/09/683501454/coast-guard-members-may-have-to-work-without-pay-during-shutdown

      The GOP may have finally figured out how to pay for tax cuts: you still provide the services but you don’t pay the workers!

      Reply
      1. ambrit

        This dynamic is beginning to resemble the joke attributed to Lenin. “The Capitalists will sell us the rope with which we hang them.”
        I cannot think of a better way to energize a general strike than this.

        Reply
      2. Chris Jonsson

        One of the essential services the Trump administration has identified is the dept that auctions offshore drilling leases for cheap. The dept in charge of detecting, stopping and cleaning up oil spills will, no doubt, be furloughed.

        Reply
  6. Larry

    Perhaps the plan is to fatigue customers over small amounts to condition them to give up appeals over larger disputes.

    Reply
  7. Homard Mard Hankee Ospetsua

    For most of the year 1982, I worked as a parlegal for a workmen’s comp law firm representing petitioners (the sick or injured workers). Almost all of the cases we handled were from workers whose disability checks had stopped after six weeks. Always six weeks. That’s the point at which the insurer would stop sending the checks and the worker would call us. Then, someone (like me) from the law firm would call the insurer. There would be one of a a stock set of about half a dozen responses, ranging from “my desk is so messy haha, but I know I saw that check in these papers somewhere” to “we don’t have the proper medical documentation” (even though of course there needed to be medical documentation for them to send the first 6 weeks’ worth of checks). After one or two phone calls from us, the checks would begin to flow again in a week or two (including checks for any week that the insurer had missed).

    Oh, and 95% of these cases were from workers whose first language wasn’t English.

    The theory of the folks who’d been at this business for awhile was that, by having a built-in delay at the six-week mark, the insurers were making a little extra interest.

    Reply
  8. cnchal

    > . . . in terms of abuses, this is small beer . . .

    Tens of millions of small beers ends up being a gigantic vat of beer for Davos Man running Cigna. This is the result of Davos Man purchasing laws to prevent class action suits, which was paid for by stealing small beers from the peasants for decades.

    I do pity the human capital at Cigna. Their worth to Davos Man is how well they steal small beers, the more they steal the higher in the organization they go, aspiring to be the next Davos Man.

    Reply
  9. Brenda Pawloski

    If you are able to send your pharmacy claims online and keep an electronic copy, you can resubmit easier, faster and more often. I have done this with Cigna. I agree it is odd how they choose to ignore random claims, but it happens enough that it seems to be intentional.

    Reply
  10. BRUCE STONE

    Have you tried sending the mailed correspondence by priority mail? Like Certified Mail–you get a tracking number– and documentation of delivery–but it’s half the cost and my insurer will routinely refuse to accept certified mail to the claim’s PO box number.
    They can’t refuse to participate in the priority mail tracking systems—and it’s as good in court as certified mail–although it does lack the signature credo from return receipt.

    Also–my insurer routinely loses my docs and has a similar time limit on claims–but I have successfullly re-submitted based on documenting the previous sent item and the tracking data from USPS–most such systems require them to accept a resubmit when you can prove you sent it within the timeframe .

    Reply
    1. Yves Smith Post author

      See the comment above. Won’t help. Only proves I sent a letter in, not what was in the letter. They can say they got the earlier letter but the claim was not in it or was unscannable.

      Reply
  11. Questa Nota

    Expecting reimbursement is a pre-existing condition and is not covered by the Plan for which you have eligibility. Refer to paragraph x.xx in section q.qq of user agreement #.##.

    Reply
      1. RMO

        “You’ve chosen the ‘never pay” plan option which clearly states (in this microdot that also serves as a period at the end of paragraph 4) that no claims you make will be honored. It’s a good choice if you never get sick. Oh… I hate to see a grown man cry Rev… So get out of my office!” (adapted from the Pythons)

        Reply
  12. Medical Quack

    Well I gave a speech last year to a big doctors group about a lot of this and have written about it for years, it’s called the Healthcare Algo Cartel. What folks can’t see and don’t want to believe is that there’s tons of quants (called non traditional actuaries in healthcare) modeling policies and finding new areas every day where coverage for certain items can be “scored” to reduce the amount the insurer will pay.

    I just don’t know how long you all want to keep living in virtual perceptions and not realize this has been going on for years, just like the stock market, algos and their query results are running everything, and folks are too busy on Facebook or screaming at a box (Alexa) to take time out and learn up. Cigna is basically emulating United Healthcare and using the same models, but they don’t own a PBM like United does or they don’t own a bank like United does (an industrial bank). That bank by the way holds a lot of HSA money and United a couple years ago bought all the Wells Fargo HSA accounts, that’s how they grow.

    Nobody mentions an exit fine either for Cigna and Express Scripts. There’s 5 years left for Cigna to be required to OptumRX as a PBM, contract signed with Catamaran, which OptumRX bought. Those folks with OptumRX as their PBM with Cigna have 5 more years before a switch to Express Scripts can be facilitated unless Cigna takes out another bond sale to pay it off.

    People need to learn up and see what’s going on, insurers are big data people and nobody seems to get that but just hang around long enough and more will come out about United Healthcare and what they and Apple are doing together, you already have United pimping Apple watches and all Apple employees are given an Optum Bank HSA account with one scratching the others back already.

    Cigna by the way has Express Scripts hitting the big coupon savings route to compete, you can search that one up. Did you know that if you use a coupon to save money on your RX that that money can’t be applied against a deductible? Time to learn up folks and see what the healthcare algos are doing, they’re denying your care and access and there’s more MBA quants on their way to be hired at insurers to model even more ways to profit by “scoring” consumers into oblivion, it’s how you don’t qualify done by queries and predictive models. The more complex they make it, the more insurers profit off of consumers not understanding the game and we don’t have the ability to fight back (we don’t have the algos and computer code).

    Reply
    1. Kris Alman

      The Cigna-Express Scripts merger is brilliant financial engineering to further consolidate insurance companies with PBMs in the fight between them and PhRMA over price gouging.

      The coupons that you can get through Good Rx is a scheme of Express Scripts. https://www.biopharmadive.com/news/express-scripts-goodrx-roll-out-cost-savings-program/442197/

      Now that Trump has signed bills lifting pharmacist ‘gag clauses’ on drug prices, the pharmacist can point you in the direction of drugs cheaper than your co-pays, which you pay-out-of-pocket and can’t claim toward your deductible. What a win for Cigna/ExpressScripts!

      Yves, I can’t believe you have been so patient with Cigna! Complain to your insurance division. Though, I will add that while this may work at the individual level, it does nothing to create systemic changes.

      Reply
    2. JerryDenim

      Sorry to be so dense, but can you elucidate a bit more on “scoring” and how health insurance companies are using your personal data they’ve purloined or surreptitiously obtained to deny care? If you’re not self-insured but receiving subsidized insurance through an employer plan are you still affected by “scoring”?

      I would never knowingly register any health monitoring device with a health insurer or employer and I’ve always thought those who do are foolish, but recently I was considering buying an Apple Watch solely for the express purpose of being able to surf while being on call for my job. I believe there may be other waterproof, cellular-enabled wrist devices in the consumer space now besides Apple, but they all seem to be equipped with health monitoring sensors as well. I would never voluntarily register such a device with any programs in exchange for discounts, but it seems like linking a watch/wrist-phone to my cell phone account would be an iron identity shackle. I would really like a tiny robust cell phone reciever to screen calls while I’m in the water, which has the ability to increase my quality of life, but I don’t want my heart rate and vitals logged and sold. I modified a song lyric a couple of decades ago to coin my own phrase; “Never mind what you’re buying, it’s what you’re selling” – It becomes more true each passing year.

      Reply
  13. jfleni

    RE: Health Insurer Greed or Desperation? An Odd Data Point From Cigna.

    The “Nitty-gritty” A Scam wrapped in a Swindle, with a Fraud right on top!
    Run -do not walk – to Medicare for ALL!

    Reply
  14. jefemt

    Not fun to do the work, but imagine a few million Cigna clients at $13.00 a pop. Will pay for attorneys and accountants.

    As to Priority Mail/ tracking/proof, why do we tolerate such a byzantine battle-prone system? Think of the man-hours Yves and countless others spend on running down this hors*#t. If she and others (doc offices/ care providers?) billed Cigna and others at a reasonable but market-based hourly rate for the collective man-hours spent on claims, Cigna et al would be out of business.

    Its a level of complexity that is completely unnecessary. Our complacency, tolerance, and acceptance is pretty astounding. Must be the very real primacy of the threat and fear that personal health prompts. Immoral to lever off of this. Care versus insurance. Insuring a mortal being. Ridiculous premis only Wall Street could concoct. And we buy it because markets, capitalism, rugged individualism, American Exceptionalism.

    Doc friends and family consistently state 35-40% of their costs, staff deals with billing, coding, reimbursement. There is huge savings to be gained in the process if we would go to a single payor system.

    But you all know that- preaching to the choir.

    I am still trying to figure out how to tie personal health choices, like diet and exercise, moderate alcohol use, etc.. and some incentivized skin-in-the game, some ‘pain’ disincentivises folks from over-using single payor and insisting on the highest dollar cost latest most expensive treatments — how can this be institutionalized?

    But , no need to reinvent the wheel- countless other nation-states have figured it out. For a nation of business-persons, we appear to be, as my old dad used to say, dumberthanwhaleshit

    Reply
    1. hunkerdown

      If they’re overusing the system, what’s the underlying reason? Probably loneliness or neurosis, either treatable on an outpatient basis as a mental/community health matter. If they demand heroic treatments or frivolous diagnostics, what’s the underlying reason? Probably the consumer model of medicine and direct-to-patient marketing of interventions, also easily treatable (through restriction of advertising) and known to work well in other nation-states. If they eat crap, what’s the underlying reason? The standard American diet is a consequence of national policy to grow grain instead of vegetables, which can be changed slowly and with effort as a public health hazard. If they don’t exercise, what’s the underlying reason? Built environments and lifestyles that are hostile to pedestrian traffic, which is not necessarily such an easy problem to solve due to the private interests and investments in the status quo, but whose opposing public interests would grow much stronger under a single-payer system.

      Yet, all of these solutions, however difficult and world-changing they might be, are more effective over the long term and less resentment-inducing than having citizens pay to be individually scourged as a service in the name of individual incentive.

      Reply
    2. Yves Smith Post author

      The overwhelming majority of people do not elect to overconsume medical care.

      People who don’t exercise often don’t have the time or money to do so (gym membership). Do not say “Anyone can run.” Running on pavement is knee replacement futures. And there are people like me who could never jog even when young.

      The ones that do fall into a few categories:

      1. Ones with “lifestyle” diseases, like diabetes due to overweight/poor diet and smoking-related diseases. Problem is that these are typically the result of stress. Very hard to get off cigarettes and harder if you are subject to stress/use nicotine as a performance drug. Obesity significantly due to American portion sizes. too many refined carbs, and again, stress. And once people get fat, it is very hard for them to take and keep the weight off. I have managed to do so by virtue of seriously undereating for 40 years (<1200 calories/day, and that includes when I was exercising vigorously pretty much daily). Most people can't do that for social reasons. It is hard to be a meager eater when you are eating with other people.

      2. People who are already have a problem and have been marketed to to demand tests and treatments. The classic version of this is doctors prescribing antibiotics to people with flus. The patients demand a treatment and the MD does not want to get in an argument. More extreme is patients not wanting to hear that there aren't any good options for what they have and shopping for an MD who will intervene anyhow. Another is all those new pricier drugs marketed on TV "Ask your doctor about..."

      Reply
      1. beth

        The best information about obesity is still the UCSF researcher Robert Lustig. He now has his own website but it not organized well to my taste and fails to keep the best long lectures there. Actually the best information in the shortest time is his first lecture that has been seen millions of times by geeks like me is “Sugar: The Bitter Truth” a one hour and 29 minute lecture he did in 2009. Youtube cuts it up and wants me to pay for it. But each time I have seen it has been on UCTV or UCSF. For those of us who want to understand the science this one is a must. There is good videos after that, but this is the foundational scientific information.

        I can’t give you a link because Google and the sugar industry makes it maddingly hard to find and moves it around.

        Reply
    3. bob

      “I am still trying to figure out how to tie personal health choices…some incentivized skin-in-the game…”

      You’re trying to noeliberalize it. “How do we build in the need for 18 layers of very well paid bureaucrats who deal out spite, and lack of care, as part of their job descriptions?”

      I can’t imagine any more ‘skin in the game’ than all of the skin, and literally all of the person.

      Do you ghouls even read what you write?

      Reply
  15. k.

    As someone who managed a medical billing office in the 80s and 90s I can assure you that insurance companies losing claims is nothing new. That’s why the advent of electronic billing to Medicare and Medicaid and BCBS and others was so wonderful. Finally, Medicare stopped “losing” all those claims we offices had to refile all of the time.

    Sometimes it helped me to envision the office I was sending the paper claim to, imagining a constant turnover of new employees who didn’t know what they were doing, or throwing away a stack of bills at the end of the day because they hadn’t met their quota.

    It’s like borrowing “your” money longer, not paying what’s owed in a contract.

    Reply
  16. EoH

    Thanks for sharing.

    This seems reminiscent of bank ATM fee scams. A dollar here, $2.50 there – systemwide – and soon you’re talking about real money. It also matters whose budget the costs or income are shifted to, which is often a highly-competitive internal game. Same with the now ubiquitous and easily incurred penalty charges, which banks use to generate the outlandish returns they now consider their due.

    Coincidentally, I was recently helping a friend with her latest medical bill. Always good sport if it’s not your bill. It was “only” for about a thousand dollars. Her insurer paid the amount, minus her deductible.

    The hospital system sent her a follow-up bill for the same service. It was for the deductible the insurer did not pay – routine – AND for another thousand dollars, which was not.

    Here’s the hospital’s argument: It had billed the insurer and the patient only a thousand dollars. But the insurer considered bills for up to two thousand dollars for that service. Having, in effect, underbilled the insurer, the hospital added the difference between its first bill and the maximum amount the insurer would consider.

    But the hospital did not bill the insurer for the higher amount, only the patient. That routine also happily avoided any reasonable and customary cap the insurer and hospital had agreed to.

    The hospital does this routine systemically. Its “customer service” operators have a canned response for outraged patients: You’ll pay it in the end and we’ll dock your credit score in the bargain. Film at eleven.

    Reply
  17. Steven Hoel

    I have found this letter (or to be used as script to be read over the phone) to be 100% effective so far. I suspect it gets kicked up to a supervisor who wants to get rid of the crazy customer:

    “To: “Big Corporation”
    Regarding Inv #

    Hello,

    You have issued your fourth notice. Please note that this is now my third notice to you of whom to bill. If I must spend more time on this issue, I will be billing out at $200 per hour in ½ hour increments. Sending a further notice without contacting “XYZ Healthshare” for payment will indicate acceptance of my terms.

    This blood work was for my annual Physical. I am covered under “XYZ Healthshare” and they cover one physical per year.

    Please submit above referenced invoice for payment to:

    “XYZ Healthshare”
    Payor ID:
    P.O. Box 1234
    Anytown USA 12345

    Insured: John Doe
    Policy # 123456789

    It is not acceptable to simply send me another payment notice when you are not billing as I instructed. I will send my billable hours in return and submit a copy to my attorney.

    Best Regards,

    John Doe”

    Reply
  18. NotTimothyGeithner

    The punditocracy wonders why more Americans aren’t worked up about Trump’s misdeeds. The great unwashed public is beset with abuses much closer to home.

    Perfect.

    Reply
    1. jrs

      Of course Trump’s misdeeds are becoming abuses much closer to home, having one’s government closed becomes real impractical even on the day to day level.

      Reply
  19. Spring Texan

    Wow, this makes me very happy I work for a self-insured employer which unfailingly pays bills in good faith. Awful.

    Reply
  20. California Bob

    I was with United Healthcare in the private sector for years, with good coverage and no serious issues (PPOs only). When I went on Medicare, I stayed with AARP-endorsed UHC; I figure the last thing UHC would want is a bunch of angry retirees with time on their hands. So far, so good.

    Reply
    1. Jimmie Q

      I don’t know about that. I’ve not been able to login to the AARP/UHC website for 2 months.
      They admit that there is a problem. After 2 months I’d say they are correct.
      You’d think they would go back to the last working version of their log-in software.
      What kind of testing was performed before inflicting this crap on their users. None, by the looks of it.
      It’s pretty obvious when you can’t login. How stupid are these people ?

      Reply
  21. Oregoncharles

    Not medical, but a similar penny-ante scam that we encountered from a car rental, which I will name: it was Dollar/thrifty – they’re the same company. Ironically, we were happy with their service, given the price, UNTIL we turned the car in at the Indianapolis airport. The agent claimed the system was down, so couldn’t give me a receipt; foolishly, and feeling time-pressured, I walked away without one (don’t do that).

    The company first claimed the car had not been turned in, then discovered that it had been re-rented the next day, so charged us for an extra day. I refused to pay it, since an agent had agreed that our boarding passes from the airline proved when we’d turned it in. In fact I got the credit card company to reverse the extra amount (their service was exemplary). Attempts to clear it up on the phone led to hangups at their end, and ultimately they sent the $50 difference to collection. When I got a call, I started yelling about it being a fraudulent charge and making legal threats; never heard from them again – not worth it for such a small amount. I felt that principle was involved.

    And now the oddity: Dollar/Thrifty belongs to Hertz, but we’ve had no trouble renting from Hertz. Go figure.

    Reply
    1. JerryDenim

      One scam I’ve seen Hertz attempt on me twice, was claiming a car wasn’t returned completely full, like 1/16th shy of full, then they proceed to charge you for a full tank of gas (15, 20 gallons or whatever that means based on the vehicle) at some outrageous price like $9.00 a gallon. It’s a scam that is always going to add up to over a hundred dollars. It’s a quick, vicious one-time burn (sharp practice as Yves would say) they try to pull on customers they figure may never rent from them again anyway. Algos I’m sure. Always document, document, document with rental cars. Cell phone cameras are great in this regard. Photos of the odometer with gas gauge displayed work great for refuting such charges.

      Reply
    2. beth

      I was definitely scammed by Dollar/Thrifty. I have switched to using Enterprise but they sometimes don’t have an airport location. So far so good. I usually take only one trip a year.

      Reply
  22. Oregoncharles

    Afterthought: Insurance is a service business, which would normally depend on providing reasonably good service – granted, in this case Yves is locked into an old contract, so they might be trying to get rid of her.

    I wonder if this sort of behavior means they see the political handwriting on the wall, figure the business can’t last much longer, and are trying to extract the last dime, because it IS the last?

    Reply
    1. EoH

      Standard business model. Nothing special.

      I question whether insurance is any longer a service, at least for the customer. Health insurance used to be a business that offered a reasonable service, service tracking and payment processing for employers, who purchased the service for their employees as a form of deferred compensation, in exchange for a reasonable fee.

      The model seems to have changed to one of open and notorious self-dealing. The intermediary has become a principal, and no fee and no level of profit is too great. The intermediary makes decisions that look to the lay person like practicing medicine – not seemingly in the interest of savings its employer customers money, but it making it for themselves. The model is a major reason for the extraordinary cost of medical care in the US.

      Reply
    1. ambrit

      That would be a tax on her time, she has to physically show up in court for the ‘trial’, and money, as in, filing fees. A small claims judgement does not guarantee payment. That could take a second suit. (I had to go for a second filing to get my judgement paid.)
      This is a systemic problem. The remedy in that elusive “perfect world” is to change the system.

      Reply
  23. AdamK

    “Corporate America has been institutionalizing penny-ante scams ”

    Don’t get me started. 24 hour fitness sold membership for super sport facilities at a higher price promoting the deal that gives free towels to members while at the gym. 3 years after, towels are gone. Price was raised several times, and there is no difference between regular facility and super sport. No one complained. They simply got the news and adjusted. Saying something is not considered appropriate, so we continue to pay more and more and getting less and less.

    Reply
    1. ambrit

      Same dynamic used for Internet services, telecom services and cable services. Life is legally an “ethics free zone” today.
      Reminds me of one of the more vulgar posters I once saw. A mid range shot of a woman’s “private parts” with a ‘tattoo’ above the mons pubis saying; “Abandon all hope, ye who enter or exit here.”

      Reply
  24. JerryDenim

    This story is strangely similar to the battles I used to wage years ago with Sallie Mae to pay down my student loan principal ahead of schedule. I would send checks that would never be cashed. If they ever were the amount would always be applied to interest and never principal. Tons of emails, phone calls and letters stretching out over months all about one check or another.

    “Oh you sent the check to that address? No that’s all wrong, try this one.” “Oh, no, you have to write a letter stating you want the amount to be applied to principal. Oh, you did already? Oh, well send one to this department at this address instead and your next one should be be applied to principal.”

    Absent an aggressive regulator corporations can play infuriating games like this for years until the consumer gives up or lawyers up. Lawyering up is no guarantee of victory and doesn’t make financial sense for small penny-ante grievances. Most people stuck dealing with hassles like these don’t have the money to lawyer up anyway and corporations know it. I remember back in 1995 when my phone service was changed without my permission and I received an outrageous bill. I placed one phone call to the FCC that lasted a few minutes and I received a $250 credit and my phone service was free for the next year. I miss those days.

    “The punditocracy wonders why more Americans aren’t worked up about Trump’s misdeeds. The great unwashed public is beset with abuses much closer to home.”

    Absolutely. It’s really tough for working class Americans to shed a tear for Central American border jumpers having a rough go of things with ICE when their own government refuses to protect them from thousands of small capitalist depredations that they are subjected to on a daily basis.

    Reply
  25. tongorad

    Corporate America has been institutionalizing penny-ante scams like the one Cigna ran on me…
    I received an errant charge when I chose to cancel my account with a phone-carrier giant. Lots of time on the phone speaking to different people, demanding to be sent an invoice/bill.
    In the end, I just paid. I was losing sleep over it.
    I have a feeling that these kinds of extractions are commonplace.
    What a world…

    Reply
    1. beth

      If we are discussing scams, I had an earthlink account for about a year when I noticed that rather than billing me monthly, they were billing me every 20 days and when I noticed it, they said they would refund my money at my request.

      And what do you think happened?

      Reply
  26. M Morrissey

    File a complaint with your state insurance department. Most departments have dedicated staff who will follow up on such issues. If you one of many victims, it can lead to a “Targeted Market Conduct Examination” of the company.

    Once that happens, the insurer will readily settle claims such as yours because besides fines, the impact of an examination damages their reputation. Also, if there is a pattern of misconduct, the complaint information is shared between the 50 states, who may also initiate targeted examinations. Don’t get mad–get even.

    Reply
  27. JBird4049

    The more people are in need of medical care the less likely they are to have the time, energy, or even money to maintain their records, read all their letters and emails, and write and call enough times to finally get their money. The sicker are the less likely you will get paid. Truly vulture capitalism.

    Reply
  28. Dan

    I tend to agree that these ‘billing mistakes’ are a conscious strategy on the part of insurers. For several years Kaiser (Northern California) would attempt to bill me $15 every time for routine physical visits (which my physician had requested!). Routine physicals, of course, are meant to be free under the ACA. Every time the receptionist would request payment in advance, I would decline an tell them that the appointment should be free. They then would proceed to bill me by mail, and I had to spend time calling them to resolve the issue. Unlike Yves’ experience with Cigna, Kaiser customer service was always friendly and promptly resolved the ‘error’.

    Since we changed from a Covered California plan to a small business plan this practice appears to have stopped, at least for me. Nonetheless, this annual ritual was a ridiculous tax on my time, and I wonder how many people who were less informed/hostile to their insurer than I am have just paid these false and illegal fees up front. The consistency of this practice over a period of years makes it hard for me to believe that there is really error involved, as opposed to a subtle fraud by the insurer.

    Reply
    1. monday1929

      It is never an “error”, and it is always in their favor (proof it is not an error).
      They target the sickest, least likely to fight back. There is an MBA somewhere who wrote an algorithm designed to screw the old and sick. My nightmare with United “healthcare” (why are they allowed to call themselves or imply they are healthcare providers?) was on behalf of someone else who never could have fought these scammers.

      Reply
  29. tiebie66

    So, they legislate to permit disruption against you and not against them, but year after year – figuratively speaking – you send the same people back there. The system is beyond reform, is that not clear by now? Vote for anyone –except– a Democrat or Republican. It would create upheaval at first, like spring cleaning, but it is as necessary. If you are too timid to make changes, you will only get weaker and weaker until you are too weak to resist. Don your yellow jackets!

    But on a different level – where does this originate? My sense is that it is a failure of education. The nation can neither read, nor write, nor think. This makes for easy victims. Do teachers really deserve better pay? Is teaching not a ‘calling’ rather than a career? Should teachers not do better? But perhaps the failure of education is also, in part, institutionalized?

    Reply
  30. Big Tap

    Speaking of insurance scams some involve a PPO type policy. More and more often I’m told at the time of service of a doctors visit to pay up front. With a PPO policy you usually don’t know exactly what you owe till after the insurance company tells you what your co-pay is and then you’re billed. When you pay up front bring overcharged intentially is the scam. Getting a refund of your own money can time consuming.

    Reply
  31. Pft

    Not only health insurance. Good luck if your house burns down and you want them to honor the contract in a timely fashion. They hold off until you accept less hoping you hate living in 2nd rate accomodations enough to cave. My sisters contract called for full replacement of all contents regardless of age. She paid a hefty premium for that. They held out for months offering less saying some of the contents were older and not worth the replacement cost which is what she wanted to avoid by paying the extra premium for the upgrade. Came to an agreement somewhere between but took 15 months before she could move back in.

    Reply
  32. EoH

    There is the basic problem that with almost every medical service, the customer does not know the price until the bill(s) show up in the mail. (Nor have they any training or experience that would enable them to choose alternative treatments or vendors.) Only later still does an insured customer find out what portion of that bill is her responsibility. And that’s without errors and intentional mis-billing, which are common.

    The usual conservative refrain that patients need more skin in the game studiously ignores that patients always have all their skin in the game, even though no one tells them the game or the rules until it’s too late. It is an environment that could only make predatory behavior flourish.

    Reply
  33. cat sick

    Live a healthy lifestyle and self insure …

    I am sure not dealing with insurance companies is a sure way to lower stress levels and therefore require much less healthcare.

    As a fairly healthy 50 year old I find that even though I have access to a good free first world healthcare system (Singapore ), never using it and paying doctors direct for all my needs is the way to go and probably costs me 10% of what a US citizen might pay for an insurance policy.

    When I am in the US and so many people you meet have “meds” that they take on a daily basis it leads me to believe that not only are the insurance companies in on the scam but also the doctors and drug companies plying people with drugs that in most cases probably make them worse off …

    The first $20 of care I would reccomend is to buy one copy each of “how not to die” and “the case against sugar” read these and then do all you can to avoid both insurance companies and doctors ….

    Reply
  34. DHG

    Went through this very crap with United Healthcare (Medicare Advantage) and my docs office over a vaccine. Docs office claimed never got the funds, ins said issued check I was never able to get a copy they would say it was between them and the docs office… Docs office threatened my stellar credit with a collection so I just paid it and then sent the claim to UHC myself, it was denied saying we are not going to pay you and the docs office. I took that letter and sent it to my docs office demanding a full refund, they refused. I then took the letter and sent a copy of it with a dispute to my credit card company demanding the charge be canceled and at the same time sent a letter to my docs office telling them I was canceling the charge and any attempt to send it to collections would be met with me owning the entire operation by the time I was done with them in court. This was in June of 2018, I have never heard another word about it from the docs office. Why should I, I had a letter saying they paid the doctors office. I still keep it all in a folder waiting…. I trust no one…

    Reply
  35. Chris Jonsson

    Yves, Have you considered contacting Wendall Potter about your troubles with Cigna. Potter has done incredible work addressing the corruption in the health insurance industry. In fact he was an executive at Cigna until he realized what they were doing, and not doing to the American public.

    Here is his Wikipedia bio. Wendell Potter (born July 16, 1951) is an American consumer advocate, New York Times bestselling author, consultant, and former health insurance industry executive. A critic of HMOs and of the tactics used by insurers, Potter is also an advocate for major reforms of the industry, including universal health care. Prior to his resignation in 2008, Potter was vice president of corporate communications for the health insurance company CIGNA.[1] In June 2009, he testified against the HMO industry in the U.S. Senate to expose health insurance industry practices.[1][2][3] He has served as senior analyst at the Center for Public Integrity, a fellow at the Center for Media and Democracy, and a consumer liaison representative to the National Association of Insurance Commissioners. Potter is a regular contributor to The Huffington Post and Healthinsurance.org.

    Potter is in the process of launching his new media venture, Tarbell, a nonprofit news website that will tackle corporate moneyed interests’ influence on energy, taxation, politics, and health care.[4][5]

    I have an article from Tarbell written by Wendall Potter about insurance lobbyists’ activities in New York called
    “Health Insurers Writing Big Checks to Democrats as Single Payer Support Grows” 06.25.2018

    I’d love to see you team up with Wendall and fight the health insurance industry stranglehold on our country.
    Sincerely, Chris Jonsson

    Reply

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