CIGNA computer glitches zap physician pay

Doctors need to be proactive in refiling claims because the insurer will not comprehensively review last year's claims on its own.

By Robert Kazel, AMNews staff. Aug. 4, 2003.

CIGNA Corp. has earmarked up to $25 million to reimburse doctors and hospitals whose claims were inaccurately processed last year as the insurer converted to a new data processing system. But doctors might not see themselves compensated for money lost due to the little-known snafus unless they're aware of the errors and make efforts to resubmit the old bills.

In early 2002, Philadelphia-based CIGNA, in an attempt to cut costs through streamlining, changed over to a new system for medical reimbursements and ran into "some human error and some errors by the computer system," said company spokesman Wendell Potter.

The mistakes were problems on two fronts: Some CIGNA patients were not recognized as members of the health plan and payment was denied to physicians, or in some cases, weren't paid in full, Potter said. In addition, the system sometimes mishandled reimbursements to doctors when it referred to old contracts for payment levels instead of more recently negotiated contracts, he said.

Though the systemic problems have been addressed, the repercussions are still being felt.

CIGNA announced July 14 that it was scaling down expectations for second-quarter earnings, mainly due to its health care segment's difficulty in facing rising medical costs and inability to attract and retain plan members adequately.

Part of the higher-than-anticipated expenses include refiled health claims received from physicians and hospitals in the past several months, according to Michael Bell, CIGNA's chief financial officer.