They’ve also made the peer to peer review process a PITA
by Wrathofsorin (2023-03-25 10:41:31)

In reply to: Cigna (and likely United Healthcare) has a system to deny  posted by IAND75

It used to be that if you wanted to appeal/do a peer to peer, you called up the number and would be transferred to a physician reviewer immediately. It was annoying, but at least you could get a thumbs up or thumbs down for your patient right away.

Now, if you call, you get put on hold and once you finally talk to a person you have to set up a future appointment to talk to a physician reviewer. That’s usually at least several days afterwards and you have to make sure you have time set aside and have the chart up and ready to go.

They also now send a letter to the patient placing the blame on the physician for not supplying enough information for them to approve the procedure or test. This leads to the patient becoming irate not at their insurance company who denied the claim but the physician’s office. In my case at least, it’s almost always nonsense as while I have many faults, detailed note taking isnt one of them.

If you had told me 15 years ago that I would be in favor of a single payer health system, I would have figured I must have lost my marbles. But the whole current system is so screwed up, I’d take it over what we have now. If all the people in the current health insurance system lost their jobs tomorrow, I wouldn’t miss a minute of sleep.