A former medical director at Cigna is blowing the whistle about a policy to “deny, deny, deny” claims, in an effort to hit performance metrics even if it meant patients would be unable to receive necessary care.  

Debby Day, MD, said she was given extensive power by the insurer to approve or reject requests for life-saving care, such as drugs and surgeries. Day’s job at Cigna was to review cases flagged for denial, a process that took time, requiring review of medical literature to ensure denying treatment was the right thing to do—and often, it wasn’t. 

In a story in ProPublica, Day said she worked for Cigna for more than 15 years and was eventually told she needed to work faster and deny more claims—or she would be fired. Colleagues in similar roles were adhering to the demand to keep up with the pace, with a dashboard dictating time allowed to review a claim. 

Complicating things further was the “increasingly sloppy” work of nurses who served up denied claims. Day said nurses, who are the first to review claims, were often denying coverage to patients whose claims should have been approved. 

“Click and close” became the mantra for work at Cigna, Day said, which ultimately meant patients were being denied care they needed. She was employed by the company until Spring of 2022.

Cigna denies many of the accusations, referring to Day as a “disgruntled former employee.”

Read the full feature from ProPublica by clicking the link below.