Whistleblower Calls Out Health Insurer Cigna

Debby Day says she and other doctors are pressured to review cases too quickly
By John Johnson,  Newser Staff
Posted May 5, 2024 12:10 PM CDT
Whistleblower Calls Out Health Insurer Cigna
   (Getty / Andres Victorero)

A ProPublica story paints the picture of health insurance giant Cigna being more concerned about productivity—mainly through speedy denials of coverage—than the health of its customers. The story is told through the prism of Dr. Debby Day, who reviewed claims at Cigna for 15 years and says her bosses pressured her to work too quickly because she consistently trailed other doctors in the number of cases cleared. "Deny, deny, deny. That's how you hit your numbers," says Day, who retired in 2022 after being placed on a performance improvement program. She says her job was on shaky ground because she had begun pushing back against the productivity push. The company describes Day as a "disgruntled" former employee and denies its policies are designed to encourage denials.

Day's job as a medical director was to review cases nurses had flagged for denial, and she says the fastest way to get them in the "done" pile was to essentially rubber-stamp them. Day says some of her colleagues did just that, but she balked because she found that the files submitted to her by nurses in the Philippines had grown increasingly sloppy in recent years. (The story provides examples of errors she caught.) "Nobody's asking you not to do quality work," her boss tells her at one point on a recorded call, but "at the end of the day, we need to get your productivity up and we don't have a lot of time to do that." Doctors were able to see each other's clearance rates on what the story describes as a "productivity dashboard," though Cigna objects to the term. Read the full story. (Or read other Longform recaps.)

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