A new lawsuit accuses Cigna of using an algorithm to automatically deny claims in bulk instead of individually reviewing each case, putting patients on the hook for bills the health insurer otherwise would have paid.
The complaint filed Monday in the Eastern District of California says Cigna uses a system called PXDX to identify discrepancies between diagnoses and the tests and services it covers for those ailments. The company then allegedly denies claims in bulk without looking into each coverage request. California law requires insurers to give each claim a “thorough, fair, and objective investigation.”
Once the claims are denied, the company allegedly has its physician reviewers sign off on batches of denials without opening each patient’s files to conduct detailed reviews. The complaint cites a March ProPublica article, which found that over a period of two months in 2022, Cigna doctors denied over 300,000 requests for payment using PXDX, spending an average of 1.2 seconds “reviewing” each request. One doctor alone denied 121,000 claims in that time period, according to the article.
This article is exclusive to STAT+ subscribers
Unlock this article — and get additional analysis of the financial innards of our health care system — by subscribing to STAT+.
Already have an account? Log in
Already have an account? Log in
About the Author Reprints
To submit a correction request, please visit our Contact Us page.
STAT encourages you to share your voice. We welcome your commentary, criticism, and expertise on our subscriber-only platform, STAT+ Connect