Cigna class action lawsuit overview:
- Who: Two Cigna plan members asked a judge to certify two classes in their class action lawsuit against Cigna Corp. and Cigna Health and Life Insurance Co.
- Why: The plaintiffs claim Cigna used an automated tool called PxDx to deny medical claims without a doctor’s review.
- Where: The Cigna class action lawsuit is pending in California federal court.
Two Cigna plan members who are suing the insurer over automated insurance denials have asked a judge to certify a nationwide class and a California class in their class action lawsuit.
Plaintiffs Michael Mahshigian and Randall Rentsch filed the motion on Oct. 30.
“Defendants Cigna Corporation and Cigna Health and Life Insurance Company decide medical claims with a machine, not a doctor,” they said in the motion.
The plaintiffs claim Cigna’s plans promise that a medical director will decide whether care is medically necessary. Instead, Cigna allegedly relies on PxDx, a fixed list that matches diagnosis codes to procedure codes. If a claim’s diagnosis code is not on the list, the system flags the claim for denial.
Mahshigian claims Cigna twice used PxDx to deny anesthesia coverage for a procedure to treat his chronic spinal pain. Rentsch, meanwhile, claims Cigna denied payment for a drug test his pain-management provider required.
The proposed nationwide class of more than 3 million people covers members of health plans governed by federal benefits law whose coverage Cigna denied through PxDx since Jan. 1, 2011. The California class of about 1.4 million people covers members of group health plans Cigna administers in the state since July 24, 2019.
The plaintiffs want an order requiring Cigna to stop the practice and reprocess every claim denied through PxDx. They also seek restitution and Cigna’s gains from the practice.
Motion states Cigna’s PxDx insurance denials produced major savings
Plaintiffs in the Cigna class action lawsuit claim the company “built [PxDx] to deny high-volume, low-dollar claims” and that PxDx generated hundreds of millions of dollars in denial-related savings. They cite a 2023 ProPublica report that Cigna medical directors denied more than 300,000 requests in two months, spending 1.2 seconds on each.
“A medical director then rubber stamps the denials in a matter of seconds, in batches of up to 50 at a time, without opening a single medical record,” the complaint says.
Cigna disagrees with the allegations. A spokesperson told Law360 the program did not use artificial intelligence or block care because claims were reviewed after treatment.
In a separate class action lawsuit, Cigna is facing accusations that it failed to properly secure consumers’ personally identifiable information and protected health information in a data breach that occurred between October 2024 and January 2025.
Has Cigna ever denied one of your medical claims? Let us know in the comments.
The plaintiffs are represented by Glenn A. Danas, Shireen M. Clarkson, Zarrina Ozari, Adrian J. Barrio, Michael A. Boelter, Derek Brandt, Grace I. Chanin and Larkin Turner of Clarkson Law Firm P.C. and Karen Hanson Riebel, David W. Asp, Simeon A. Morbey, Derek C. Waller, Emma Ritter Gordon and Margaret Eve Grabau of Lockridge Grindal Nauen PLLC.
The Cigna class action lawsuit is Kisting-Leung, et al. v. Cigna Corporation, et al., Case No. 2:23-cv-01477, in the U.S. District Court for the Eastern District of California.
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