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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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84 thoughts onCigna class action claims software automatically denies large batches of claims without review
I had Cigna for a whole year n as soon as I got hurt n went to the doctor,they cancell my insurance n told the doctor that have to return the payments
Yes, current employee and I have not had any issues as of yet. I know, people who have though.
I have had cigna for 2 years now. I had back surgery and literally every test my Dr’s needed to run got denied had to fight for everything. My surgery was a failed surgery 1 year ago and to this day I still am getting denied my mris to figure out what went wrong. Cigna is the worst. They claim to have 3 Dr’s that look over and decide whether they feel the procedure is necessary. Not my Dr
Been denied medical treatment and medication
I’ve had Cigna for over 15 years some things were denied
I have denial letters over 10 years maybe longer for medicine my doctors prescribe for a neck and back injury. Gone the withdrawals many times. Because sometimes I cannot afford the medication always by myself. Even though it should be covered., By Cigna.
I hope you guys make them pay for all the suffering many like me. Have to go through. Just a few months ago all of a sudden they approved it 3 months in a row.
Same here
I have had Cigna Insurance for 4 plus years. I got denied last year for a MRI on my lower back. They told my doctor that you only can get an MRI if you’re going to have back surgery. How can you know if you need surgery without the MRI first?
Please contact.
How do I get in contact with you?
Was in a car accident, injured both shoulders and low back. Eventually got MRI on my L shoulder and when I completed PT and Dr requested MRI for my R shoulder (surgery is scheduled right now) was denied and had to fight and appeal to get it approved.
Yes i had cigna for 1 year
I have been on a life saving oxygen machine for eight years. All of a sudden this year, CIGNA denied my claims, and said it was not needed. I have a paralyzed diaphragm, respiratory failure, a partially collapsed left lung, dangerous high levels of CO2, among other issues. I had to find another insurance company, but still getting bills for over $15,000.00 from my oxygen company.