Sunday Slacker: Trust Me, I'm A Doctor
Doctor adjacent, anyway
I know it’s Monday. I was slacking.
Links are at the end, in the links penalty box.
“We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
Cigna is a for-profit company providing health insurance to millions of people, including more than a half million Medicare Advantage customers, but not surprisingly it turns out that the “health” part of the equation isn’t as important as the profit part.1
Before health insurers reject claims for medical reasons, company doctors must review them, according to insurance laws and regulations in many states. Medical directors are expected to examine patient records, review coverage policies and use their expertise to decide whether to approve or deny claims, regulators said. This process helps avoid unfair denials.
But the Cigna review system that blocked van Terheyden’s claim bypasses those steps. Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches, according to interviews with former employees who spoke on condition of anonymity.
The ProPublica story is based in part on former Cigna employees and in part on internal Cigna documents, some of which showed that the company’s doctors rejected 300,000 claims during a two-month period in which they spent “an average of 1.2 seconds on each case.”
Doctors in any practice are expected to spend as little time as possible with patients these days, but 1.2 seconds to determine whether some other doctor’s patient gets a recommended treatment seems a little unreasonable.
One can’t really analyze unspoken motives from afar, but let’s do so anyway. It would seem that in order to routinely affect people’s lives for the worse, sometimes dramatically, with so little consideration, a doctor would have to view patients as either the enemy or irrelevant.
We know from an earlier ProPublica story, this one about UnitedHealth, that at least some people within the companies view patients as the adversary, and that devising reasons to deny treatment is the highest priority with patients who are costing the company a lot of money. In this earlier story, employees were aggrieved by the patient’s continued pursuit of treatment, and one of the company’s doctors lied about having gotten approval for an ineffective treatment from the treating physician.2
Ah well. So it is, so it has always been, and we’re fools to fight, yr. editor is told.
Arms, man. I mean: arms! Whoa
Arms, it turns out, are useful appendages.3
Palantir itself was described in pilot documents as a “sub-processor” of the data, which is a legal term given to a third party that has permission to process information gathered by others.
Palantir is the spy tech agency founded by reactionary libertarian Peter Thiel, a Trump supporter and the primary bankroller of J.D. Vance, his former employee who won a Senate seat this past November. Now, England’s National Health Service has ordered NHS health care providers to upload patient information to Thiel’s company. (Thiel is publicly scornful of the NHS.)4
Naturally the right-wing government and Palantir insist that the data will be thoroughly anonymized. And if you can’t trust two bitter opponents of the NHS, who can you trust?
[L]awyers questioned whether consent requirements – which are needed to process pseudonymised data – had been violated, and what safeguards, if any, had been put in place to protect patient privacy.
NHS England has still not sent a substantive reply after more than three months but has now instructed all trusts to implement Faster Data Flows.
Ah well.
AP’s Photos of the Week
The Associated Press has some of the best photojournalists in the world, and every week the agency shows them off.5
Music
Slacking off on the music too. I listened to this one twice through, along with the live performance at the link.
Aldous Harding, “Warm Chris;”6
And that, Comrades, is all there is. Back home in a few days.
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Take care, be well.
I don't think the Cigna doctors hate the insureds; they think they are irrelevant. What's involved is money.