July 25, 2023
NONA TEPPER
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 Golden State members. Lawyers anticipate more insurers will be hit with similar complaints as carriers increasingly automate their claims management processes.
Enrollees Suzanne Kisting-Leung and Ayesha Smiley sued Cigna in the U.S. District Court for the Eastern District of California, alleging the company used an algorithm called PXDX to review patient claims, which violated its fiduciary duty dictated by state law.