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Medically Necessary

Health insurers have wide discretion in crafting what their policies cover, and they often deny claims for services they deem not “medically necessary.” An investigation by ProPublica and Capitol Forum revealed that Cigna, one of the largest health insurers in the country (and ProPublica’s insurance provider), built a system that allows its doctors to swiftly reject a claim on medical grounds without opening the patient file, leaving patients with unexpected bills. Using this method, one Cigna doctor single-handedly rejected 60,000 claims in a single month. When UnitedHealthcare refused to pay for Christopher McNaughton's treatment, his family did something rare: they fought back. The ensuing lawsuit uncovered a trove of internal documents that gave ProPublica a behind-the-scenes look at how United Healthcare relentlessly fights to reduce spending on care, even as profits rise to record levels. At this event, reporters and insiders will explain how health insurance companies approach and process patient claims, and how this is influenced by their bottom lines. Experts will also discuss patients’ rights and potential fixes for America’s broken health insurance industry. Speakers include: T. Christian Miller, ProPublica senior editor (moderator) Dr. David Rubin, professor and chief of gastroenterology at the University of Chicago Medicine Maya Miller, ProPublica engagement reporter Mona Shah, senior director of policy and strategy at Community Catalyst Patrick Rucker, Capitol Forum reporter Ron Howrigon, former Cigna executive and current president of Fulcrum Strategies, a health care consulting firm specializing in payer contract negotiation Sign up for ProPublica’s weekly newsletter: http://propub.li/2oyN8DY Follow ProPublica on Twitter: http://propub.li/1fFfkwy Follow ProPublica on Facebook: http://propub.ca/1EIvjjF