July 31, 2023
Payers | Tea Leaves
  • Two Cigna members filed a lawsuit seeking class-action status in a California federal court on Monday, alleging the health insurance company leveraged an algorithm to improperly deny claims and systematically shift costs to its 2.1 million members. Lawyers anticipate more insurers will be hit with similar complaints as carriers increasingly automate their claims management processes. Monday’s lawsuit comes in response to a March report by the ProPublica news outlet that Cigna used PXDX to reject bundles of patients’ claims for health care services without reviewing individual members’ medical necessity. The report triggered an investigation by the House Energy and Commerce Committee and several state and federal regulators in May. The investigation is ongoing. (Article here)