Research Opportunities of a New Private Health Insurance Claims Form

Instructions and help about Research Opportunities Of A New Private Health Insurance Claims

S DENY CLAIMS, AN APPEAL IS NOT LIKELY. FEDERAL DATA SHOWS COMPANIES ISSUED 49 MILLION DENIALS IN '21. CUSTOMERS APPEALED .2 OF 1% OF THEM. WHILE SOME DENIALS COME WITH SPECIFICS, MOST EXPLANATIONS ARE VAGUE. ALLY EXPLORES HOW ONE MAJOR COMPANY IS USING AI TO ASSESS AND OFTEN DENY CLAIMS IN BULK. REPORTER: INVESTIGATIVE JOURNALIST AT PRO-PUBLIC A FOUND CIGNA USES AN AUTOMATED SYSTEM TO INSTANTLY REJECT CLAIMS ON MEDICAL GROUNDS WITHOUT OPENING THE CUSTOMER FILE. SUMMER ACCUSING IT OF USING THE SYSTEM TO HELP CUT COST, WHICH CIGNA DENIES. RYAN MILLER WORKED ON THIS STORY, MAIA, THANK YOU FOR JOINING US. EXPLAIN HOW THE SYSTEM WORKS. >> WHEN YOU GO TO A DOCTOR OR SEE YOUR PROVIDER, THEY WILL SEND IN A CLAIM TO YOUR HEALTH INSURANCE PLAN. THEY WILL LIST THE DIAGNOSIS THEY THINK YOU HAVE AND TESTS OR PROCEDURES THEY WANT TO RUN. THERE IS A PROCESS DEVELOPED AT CIGNA A DECADE AGO IN WHICH THEY CREATED THIS CODE, COMPUTER CODE, ALGORITHM, THAT SAYS WE WILL APPROVE THEM IF THEY MATCH CERTAIN