From Jill Shepherd, ProPublica <[email protected]>
Subject “Deny, deny, deny. That’s how you hit your numbers.”
Date April 29, 2024 3:24 PM
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ProPublica ProPublica <[link removed]>

Hi Reader,

For most people, the inner workings of their health insurer are a black box: Requests to cover treatment or pay claims go in, and approvals or rejections are spit out. ProPublica’s “Uncovered <[link removed]>” series has been exposing how health plans refuse to pay for care at the expense of patient well-being. With help from corporate insiders, recordings and internal emails, our reporters are revealing how the insurance industry denies coverage to patients, and those articles are inspiring individuals to appeal their cases and regulators to intervene. Today, we’ve published another eye-opening story. This entire series is made possible with donor support, and I hope today’s story inspires you to join us with your gift of any amount. <[link removed]>

In our latest piece <[link removed]>, in partnership with The Capitol Forum, ProPublica reporting takes readers inside the world of the insurance industry’s medical directors — doctors who have sweeping power to decide whether to pay for vital care. Our reporting reveals how one of the nation’s largest insurance companies tracks every minute that its staff doctors spend deciding whether to pay for health care, which some said sent the message loud and clear that Cigna valued speed. Dr. Debby Day, who worked at Cigna for nearly two decades, told us that her bosses pressured her to review patients’ cases too quickly and ultimately threatened to fire her if she didn’t get her numbers up. Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers,” she said.

Cigna described Day as a disgruntled former employee and said it expects its doctors to “perform thorough, objective, independent and accurate reviews in accordance with our coverage policies.”

But this is not the first time ProPublica reporting has cast critical doubt on the insurance industry’s management of the doctors they employ to assess patient claims. In December, we revealed <[link removed]> that at least a dozen doctors were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments. ProPublica’s reporting calls into question both these individual doctors’ judgment and the industry’s hiring practices.

Since 2022, our “Uncovered” series has been committed to scrutinizing how health insurance companies deny tens of millions of claims every year, and to holding that industry to account. ProPublica is able to put so many reporters, data experts, researchers and more on this case because of folks like you. As a nonprofit newsroom, our funding comes from donations. <[link removed]> Each year, tens of thousands of readers who know how important it is to dig up and expose corruption and bad behavior make gifts of all sizes to us to ensure we can keep at it. And we do. Seventeen stories and counting have been published in this series alone.

Today, I’m asking you to join us. Make your gift of any amount and be a part of this amazing group of people standing with us and supporting this critical work. <[link removed]> If you’re in a position to do so, I’d be so grateful if you’d join us today.

Thanks so much, Jill Shepherd Proud ProPublican <[link removed]>

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