A new lawsuit accuses Cigna of utilizing an algorithm to mechanically 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 Jap District of California says Cigna makes use of a system referred to as PXDX to determine discrepancies between diagnoses and the checks and companies 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 provide every declare a “thorough, truthful, 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 recordsdata to conduct detailed opinions. 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 cost utilizing PXDX, spending a median of 1.2 seconds “reviewing” every request. One physician alone denied 121,000 claims in that point interval, in line with the article.