Insurance Giant Cigna Faces Class Action Lawsuit for Denying Health Claims via Algorithm
A class action lawsuit has been filed in California against insurance company Cigna, alleging that they used an algorithm to review and reject hundreds of thousands of health insurance claims made by patients. The lawsuit claims that Cigna violated California state law by failing to conduct a thorough, fair, and objective investigation into each claim, instead relying on their PxDx algorithm to automatically deny claims without proper review.
According to the lawsuit, Cigna’s doctors instantly reject claims without even opening patient files, leaving thousands of patients without coverage and facing unexpected bills. In one case, a California woman who had an ultrasound to potentially detect ovarian cancer had her claim denied by Cigna, stating that the procedure was unnecessary. Similar cases were reported, indicating a widespread problem. The suit also highlighted that Cigna’s doctors denied over 300,000 requests for payment in just two months, spending an average of only 1.2 seconds reviewing each request.
This lawsuit comes after an investigation by ProPublica, which revealed details about how Cigna’s algorithm approves and denies claims in batches, flagging discrepancies between diagnoses and the procedures deemed acceptable by the company for underlying ailments. The lawsuit also raises concerns about patient privacy and the potential for errors when relying on artificial intelligence for crucial healthcare decisions.
Cigna is not the only company incorporating AI into its processes. Google’s cloud division recently launched new tools to process healthcare claims using AI, claiming it can streamline decision-making and data organization. However, the use of AI in healthcare, especially for claims processing, raises questions about patient rights and the need for human oversight.
Clarkson Law of Malibu is representing the plaintiffs in this case, which is not their first AI-related lawsuit. The same firm previously filed a suit against Open AI, the company behind ChatGPT, as well as Google, for allegedly stealing data from millions of people to train their AI products.
It is important to find a balance between the benefits of AI in healthcare and the potential drawbacks. While AI has the potential to assist in diagnosis and paperwork, human professionals should still handle critical decision-making processes. Patients deserve a thorough and fair evaluation of their claims, adhering to relevant laws and ensuring their privacy.
As this class action lawsuit against Cigna unfolds, it will shed light on the ethical and legal implications of relying on algorithms to make important decisions regarding individuals’ healthcare coverage. The outcome of this case could influence how insurance companies and other healthcare organizations use AI in the future, ensuring that patient care and rights are prioritized.
