Cigna PxDx accelerates health insurance claim denials

Occurred: March 2023

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US healthcare insurance company Cigna came under fire for using AI and automation to accelerate the processing and denial of claims. A ProPublica investigation accused the company of treating patients unfairly and unethically, and resulted in criticism from patient groups and federal lawmakers.

According to ProPublica, Cigna's PxDx system enables doctors to reject patients' claims using a bulk electronic signature without opening or reviewing their files, and to save money by turning down claims it had once paid. In 2022, 80 percent of Medicare Advantage coverage denials were overturned, and over 300,000 claims over 2 months denied in this manner. 

US House Energy and Commerce Committee members wrote to Cigna CEO David Cordani asking him to offer a detailed explanation of the PxDx review process and usage, and requesting that he provides internal documents about its conception and implementation and business impact

Cigna responded by arguing the system had been designed to rapidly approve claims, not reject them, and that it 'involves simple sorting technology that has been used for more than a decade – it matches up codes, and does not involve algorithms, artificial intelligence, or machine learning.'

In July 2023, Ayesha Smiley and Suzanne Kisting-Leung sued (pdf) Cigna, arguing its claim reviews were not 'thorough,' 'fair,' or 'objective', as demanded under California law. 

Operator: Cigna
Developer: Cigna

Country: USA

Sector: Health

Purpose: Review insurance claims

Technology: Classification algorithm
Issue: Anthropomorphism
Transparency: Governance; Black box


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Type: Incident
Published: July 2023