September 30, 2023

A new lawsuit accuses Cigna of utilizing an algorithm to robotically deny claims in bulk as an alternative of individually reviewing every case, placing sufferers on the hook for payments the well being insurer in any other case would have paid.

The complaint filed Monday within the Japanese District of California says Cigna makes use of a system referred to as PXDX to determine discrepancies between diagnoses and the exams and providers it covers for these illnesses. The corporate then allegedly denies claims in bulk with out trying into every protection request. California law requires insurers to offer every declare a “thorough, honest, and goal investigation.”

As soon as the claims are denied, the corporate allegedly has its doctor reviewers log out on batches of denials with out opening every affected person’s information to conduct detailed evaluations. The criticism cites a March ProPublica article, which discovered that over a interval of two months in 2022, Cigna medical doctors denied over 300,000 requests for fee utilizing PXDX, spending a mean of 1.2 seconds “reviewing” every request. One physician alone denied 121,000 claims in that point interval, in keeping with the article.

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