DEATH PANELS ABROAD: Cigna Whistleblower Reveals How Employees in the Philippines Play a Key Roll in Denying Care for American Beneficiaries
Also, Cigna medical directors spend, on average, four minutes to decide on complicated cases.
By WENDELL POTTER – APR 29, 2024
If you are enrolled in a Cigna health plan–and possibly any other health plan operated by Big Insurance–someone in the Philippines likely plays an important role in whether you will get the treatment or medications your doctor says could save your life.
As unsettling as that is, it gets worse: If that person in the Philippines disagrees with your doctor, he or she will flag it for a Cigna medical director who will spend, on average, four minutes deciding your fate. If that medical director spends more time reviewing your “case,” they could be singled out as an outlier, putting their compensation–and very possibly their job–at risk.
That is not just my opinion or even just based on my own personal experience as a former Cigna executive. It is based on an explosive investigative report published this morning by ProPublica and Capitol Forum.
Here’s what else I know from my two decades in the health insurance business: That medical director who has your life in their hands will also not want to be an outlier when it comes to denying coverage, which, for all practical purposes, is the same as denying the care you need. If a medical director at a big insurance company denies too few “prior authorization” requests and falls out of sync with their peers or the corporation’s metrics-based expectations, they could find themselves at the bottom of the dreaded “forced ranking” list of employees to be fired at the end of the year. That, folks, is at the heart of what insurance company executives are saying to investors and Wall Street financial analysts when they talk in coded language about the “medical management” levers they can pull to boost profits.
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Just the headline of the story sent chills up my spine and my heart racing: A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her.
Then came the subhead: Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast then being right: “Deny, deny, deny. That’s how you hit your numbers,” Day said.
Day reached a breaking point and became a whistleblower. I never met her; she joined the company around the time I left, but I know what she told the reporters was far from unique.
Reading the story brought back the nightmare a family experienced when a Cigna medical director denied coverage for a liver transplant for 17-year-old Nataline Sarkysian. Bad publicity around that case became so intense Cigna eventually caved and agreed to cover the procedure. But that reversal came several days after a Cigna medical director in Pittsburgh–2,500 miles from the Los Angeles hospital where Nataline was a patient–refused to authorize coverage for the transplant. Nataline grew sicker with each passing day and died five hours after Cigna’s change of heart. That was the final straw for me and contributed more than anything else to my decision to walk away from my career and become a whistleblower myself, before Congress, in 2009
