Class-action lawsuit filed against Cigna over alleged use of algorithm to reject patient claims

The following is from CBS News’ Market Watch.

Cigna is using an algorithm to review — and often reject — hundreds of thousands of patient health insurance claims, a new lawsuit claims, with doctors rubber-stamping those denials without individually reviewing each case. 

The class-action suit, filed in the U.S. District Court in Sacramento, alleges that Cigna’s actions violate California state law, which requires that insurers conduct a “thorough, fair and objective” investigation into each patient claim.

Instead, the lawsuit alleges, Cigna is relying on an algorithm, called PxDx, that saves the insurer money by denying claims.

The system also reduces the company’s labor costs by cutting the time needed by doctors to look at each claim, according to the complaint.

The litigation highlights the growing use of algorithms and artificial intelligence to handle tasks that were once routinely handled by human workers.

At issue in health care is whether a computer program can provide the kind of “thorough, fair, and objective” decision that a human medical professional would bring in evaluating a patient’s claim. 

“Relying on the PXDX system, Cigna’s doctors instantly reject claims on medical grounds without ever opening patient files, leaving thousands of patients effectively without coverage and with unexpected bills,” the suit alleges.

It added, “The scope of this problem is massive. For example, over a period of two months in 2022, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of just 1.2 seconds ‘reviewing’ each request.”

The case was brought by Clarkson Law Firm, which has also sued Google-parent Alphabet over its use of AI, claiming that the search giant stole data from millions of users to train the program.

In a statement to CBS News, Cigna called the lawsuit “highly questionable.”

“Based on our initial research, we cannot confirm that these individuals were impacted by PxDx at all,” the insurer said. “To be clear, Cigna uses technology to verify that the codes on some of the most common, low-cost procedures are submitted correctly based on our publicly available coverage policies, and this is done to help expedite physician reimbursement.”

The insurance claims review occurs after patients have received treatment and “does not result in any denials of care,” Cigna added.

Read complete article here.

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6 thoughts on “Class-action lawsuit filed against Cigna over alleged use of algorithm to reject patient claims”

  1. Sharyl and Full Measure Team,

    Sharyl, recall my post ( here ) about
    MSM folks not using the PROTECTIVE
    term, “alleged,” as you’ve done in your
    title to that article.

    MSM have called Trump, “LIAR,” in
    every report—without that protective
    legal term, since the 2020 (s)election

    Trump did WIN ! :

    Forwarded Message :
    — Trump Indictment by Lawyer and Ham Sandwich Specialist—Chef Jack Smith : —

    Chef Jack Smith is the King of Ham-Sandwich
    makers – among crooked lawyers – serving-up
    an anti-Trump/multi-layered “sandwich” specialty
    in Washington D.C.—dripping with duplicity,
    magical conjuring, and impress-those-gals
    narcissism :

    “So, the best they could do was to charge Mr. Trump with objecting vocally to an election that looked as rotten as Hunter’s uncapped teeth? We all saw what happened overnight November 3 and 4, 2020: what the numbers looked like in the swing precincts at midnight and the magic mathematics that swapped tens of thousands of votes over from the Trump column to the Biden column (say, whu?) … the shutdown of the Fulton County State Farm Arena due to a supposedly leaking toilet and the ensuing monkey business with rolly-bags full of ballots under the tables captured by the closed-circuit cameras… the miraculous wee-hour harvest of ballots in Milwaukee… US Postal Service truck full of completed ballots out of Bethpage, Long Island, that turned up in Philadelphia… Mark Zuckerberg’s $419-million-dollar operation using two front orgs, the Center for Technology and Civic Life (CTCL) and the Center for Election Innovation and Research (CEIR) to staff precinct election boards with party shills and buy votes… the thumb drives and modems in the vote-counting machines….

    “Special Counsel Jack Smith may find it difficult to prove that expressing an opinion about all that is some kind of crime. Meanwhile, he’s turned Mr. Trump into the poster boy for the many other aggrieved victims of a government weaponized against its own people. More than half the country sees exactly what’s going on and no amount of video footage showing “JB” and Jill holding hands on the beach is going cover for that. We are on the threshold of a king-hell national crisis.”
    —by Howard Kunstler

    Above quotes found in here :


  2. This article and more A.I. causing criminal activity ? I also been noticing putvof the ordinary posts on MSN main News webpage I cannot help but wonder if its now using A.I. articles . One article was suggesting Dolly Parton passed away ( Dead ) just a few minutes ago. Another article was saying Supreme Court Justice Clarence Thomas was leading two lives trading Sexual Favors for Fancy expensive RV’s ..I find many articles on that website hard to believe in given Month’s and wonder if there posting A.I. Fake type articles to get people to visit and click on them Anyhow ?? I cannot and do not want to picture Clarence Thomas wearing Women’s lipstick and wearing candy pants Panties on, for a New RV. with the TMZ crew on the ground laughing ? “You silly MSN website ?

  3. Sharyl, You are one of the few real investigative reporters remaining in media, I look forward to your show every Sunday and am amazed at the vast difference between the quality of your reporting versus that of 99% of your peers who seem lazy and just “call it in”, which allowed Trump enemies to push lies for years and most recently has permitted the Biden coverup. Thanks for bringing us the rare commodity of truthful reporting.

  4. No denial of care? Doesn’t it occur that if practitioners aren’t paid they’re going to quit taking insurance? Or do they think the provider doesn’t matter in obtaining care. Amazing they are so self righteous. Don’t worry you still got treatment! Sorry we lost the doctor you prefer because of the difficulty he had getting paid!

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