Cigna Saves Millions by Having Its Doctors Reject Claims Without Reading Them

Re:Cigna Saves Millions by Having Its Doctors Reject Claims ... by ClumsyPilot on Saturday March 25, 2023 @06:27PM (#35308146)

I understand that, but how is it legal to refuse to fullfil your insurance obligations without revealing the reasons?

Like in US insurance is at will, okay, fine.

But insurance is surely under a legal obligation to fullfill their end if the bargain?

[ Parent | on HN ]

Re:Cigna Saves Millions by Having Its Doctors Reject Claims ... by loa_in_ on Saturday March 25, 2023 @06:56PM (#35308420)

I don't think you understand. They only have to make case for "their end" to not apply to the specific case, and it's okay. Same as firing someone for incompetence because you suspect them of theft. Realize, an employer has this option always. Why bother "playing the game".

> [...]you can't fire someone or deny coverage based on reasons that can be contested. It's not fraud if you fire them for some other reason. It's not fraud if you don't even know why you denied coverage.

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