CBS News By Aimee Picchi 7/26/2023
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.
One California woman with Cigna health insurance, Suzanne Kisting-Leung, underwent an ultrasound ordered by her doctor because of concerns about ovarian cancer. The ultrasound found a cyst on her left ovary, the lawsuit states. Cigna denied her claim for the ultrasound and a follow-up procedure, claiming neither were medically necessary and leaving her on the hook for $723 in costs for the two ultrasounds, the claim alleges.
Another Cigna customer in California had a vitamin D test to check for a deficiency, a procedure that was ordered by her doctor. Cigna denied her claim, but didn't provide an explanation about why the test was rejected, the suit claims.
More:
https://www.cbsnews.com/news/cigna-algorithm-patient-claims-lawsuit/
