Cigna PxDx accelerates health insurance claim denials
Occurred: March 2023
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.
Consumers for Quality Care (2023). Investigative Report Shows Health Care Insurance Company Cigna Denies Claims
NAMAS (2023). The House Always Wins – PXDX Edition
Un-covered (2023). Exposing how health insurance companies put wealth over health
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Published: July 2023