A new lawsuit accuses Cigna of using an algorithm to automatically deny claims in bulk rather than reviewing each case individually, leaving patients on the line for medical expenses the health insurer would have otherwise covered.
The complaint filed on Monday in the Eastern District of California alleges that Cigna uses a system called PXDX to identify discrepancies between diagnoses and the testing and services covered for those conditions.
The company allegedly then denies claims en masse without examining each coverage request individually. The law in California requires insurers to investigate each claim “thoroughly, fairly, and objectively.”
Once claims are denied, the company allegedly has its physician evaluators sign off on batches of denials without conducting detailed reviews of each patient’s file. According to a March ProPublica article, Cigna physicians denied over 300,000 requests for payment using PXDX over a two-month period in 2022, spending an average of 1.2 seconds “reviewing” each request. According to the article, one doctor alone denied 121,000 claims during the specified time period.