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Fred's CIGNA Scam
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<blockquote data-quote="Ricochet1a" data-source="post: 593372" data-attributes="member: 22880"><p>Gee... </p><p> </p><p>The only possible issue out of FedEx's self-funding of its health insurance plans through CIGNA would be if CIGNA receives any sort of financial incentive to refuse permission for treatment coverage. Health insurance plans through HMO's have an incentive program for providers to minimize expenses each year in exchange for a "bonus" payment. This is perfectly legal. </p><p> </p><p>If CIGNA receives any sort of "bonus" from FedEx for keeping total payments to providers under a certain threshold (per employee covered), then there might be an issue. Since all these contracts are kept very private, it would take a whistleblower to reveal if an arrangement like this existed. Again, I doubt there would be any illegality if this sort of arrangment did in fact exist. </p><p> </p><p>Logic dictates that there has to be some sort of clause in the contract for CIGNA to do its best to minimize covered expenses for FedEx. After all, with CIGNA acting as just an administrator for the plan (having no direct financial stake in the payments made to providers), there has to be some motivating factor to make CIGNA act as if they were spending their own money to cover payments instead of FedEx's. I seriously doubt FedEx would have a contract with CIGNA that allowed them to essentially rubber stamp all claims to have FedEx pick up the final bill. </p><p> </p><p>The change in insurance coverage is that in the past insurance providers assumed the claim was vaild and made payment. Now, insurers place the burden of proof on the insured and health provider for all claims submitted. Given the skyrocketing costs of health coverage in the past 15 years or so, this isn't too surprising. </p><p> </p><p>Without getting into too much personal detail, I had an experience a few years ago with providers (not CIGNA), that took almost 6 months to completely resolve. The irritating thing is that it took about 30 hours of my time in phone calls, traveling and correspondence to resolve. The fortunate thing is that in the end all the insurance companies involved paid up (there was multiple insurance coverage) and I was left paying out of pocket about 3% of the total bill for services (what I should've paid under the circumstances). The bills were in excess of $100,000 for the service provided by all parties (physicians, hospitals, ambulance, etc.)</p></blockquote><p></p>
[QUOTE="Ricochet1a, post: 593372, member: 22880"] Gee... The only possible issue out of FedEx's self-funding of its health insurance plans through CIGNA would be if CIGNA receives any sort of financial incentive to refuse permission for treatment coverage. Health insurance plans through HMO's have an incentive program for providers to minimize expenses each year in exchange for a "bonus" payment. This is perfectly legal. If CIGNA receives any sort of "bonus" from FedEx for keeping total payments to providers under a certain threshold (per employee covered), then there might be an issue. Since all these contracts are kept very private, it would take a whistleblower to reveal if an arrangement like this existed. Again, I doubt there would be any illegality if this sort of arrangment did in fact exist. Logic dictates that there has to be some sort of clause in the contract for CIGNA to do its best to minimize covered expenses for FedEx. After all, with CIGNA acting as just an administrator for the plan (having no direct financial stake in the payments made to providers), there has to be some motivating factor to make CIGNA act as if they were spending their own money to cover payments instead of FedEx's. I seriously doubt FedEx would have a contract with CIGNA that allowed them to essentially rubber stamp all claims to have FedEx pick up the final bill. The change in insurance coverage is that in the past insurance providers assumed the claim was vaild and made payment. Now, insurers place the burden of proof on the insured and health provider for all claims submitted. Given the skyrocketing costs of health coverage in the past 15 years or so, this isn't too surprising. Without getting into too much personal detail, I had an experience a few years ago with providers (not CIGNA), that took almost 6 months to completely resolve. The irritating thing is that it took about 30 hours of my time in phone calls, traveling and correspondence to resolve. The fortunate thing is that in the end all the insurance companies involved paid up (there was multiple insurance coverage) and I was left paying out of pocket about 3% of the total bill for services (what I should've paid under the circumstances). The bills were in excess of $100,000 for the service provided by all parties (physicians, hospitals, ambulance, etc.) [/QUOTE]
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