Cigna lawsuit over algorithm allegations could be first of many

July 25, 2023


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.

The two are seeking monetary damages and an injunction for the health insurance company to stop using PXDX in claims management.

“PXDX is a simple tool to accelerate physician payments that has been grossly mischaracterized in the press,” a Cigna spokesperson wrote in response to a request for comment. “The facts speak for themselves and we will continue to set the record straight.”

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