Cigna class action claims software automatically denies large batches of claims without review

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Cigna claims class action lawsuit overview: 

• Who: Hannah Veinbergs filed a class action lawsuit against Cigna Corp. and Cigna Health and Life Insurance Co. 
• Why: Veinbergs claims Cigna uses an algorithm to automatically deny payment requests for necessary medical procedures en masse. 
• Where: The class action lawsuit was filed in California federal court. 

Cigna systematically, wrongfully and automatically denies insurance claims for patients needing necessary medical procedures that are owed to them under Cigna’s health insurance policies, a new class action lawsuit alleges. 

Plaintiff Hannah Veinbergs claims Cigna has developed an algorithm that enables its doctors to “automatically deny payments in batches of hundreds or thousands at a time for treatments that do not match certain preset criteria.” 

The plaintiff argues the algorithm, called procedure-to-diagnosis — or PXDX — is able to evade the legally required individual physician review process for insurance claims. 

“Relying on the PXDX system, Cigna’s doctors instantly reject claims on medical grounds without ever opening patient files, leaving thousands of patients effectively without coverage and with unexpected bills,” the Cigna class action states. 

The plaintiff wants to represent a nationwide class and California subclass of individuals who have purchased health insurance from Cigna, from the beginning of the applicable liability period to the present. 

Cigna doctors denied more than 300,000 payment requests using PXDX method within two months last year, class action says

Veinbergs claims Cigna doctors denied more than 300,000 payment requests using its PXDX method over a period of two months last year, while allegedly spending an average of only 1.2 seconds “reviewing” each request. 

“Cigna failed to use reasonable standards in evaluating the individual claims of Plaintiff and the Class members and instead allowed its doctors to sign off on the denials in batches,” the Cigna class action states. 

Veinbergs claims Cigna is guilty of unjust enrichment, intentional interference with contractual relations and breach of the implied covenant of good faith and fair dealing, and of violating California’s Unfair Competition Law. 

The plaintiff is demanding a jury trial and requesting declaratory and injunctive relief along with an award of, compensatory, incidental or consequential damages, and punitive or exemplary damages for herself and all class members. 

A separate complaint was filed against Cigna in 2017 — and unsealed in 2020 — over claims the company submitted fraudulent claims to Medicare Advantage and overbilled by more than $1.4 billion from between 2012 and 2017. 

Have you purchased health insurance from Cigna? Let us know in the comments.

The plaintiff is represented by Michael R. Reese, George V. Granade and Charles D. Moore of Reese LLP, and Kevin Laukaitis of Laukaitis Law LLC.

The Cigna claims class action lawsuit is Veinbergs v. Cigna Corp., et al., Case No. 3:23-cv-01540, in the U.S. District Court for the Southern District of California.

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