The class-action suit was filed in California by plaintiffs Suzanne Kisting-Leung and Ayesha Smiley, who were denied coverage by Cigna based on a decision made by its PXDX digital claims system.
Ms. Kisting-Leung was referred for an ultrasound because of a suspected risk of ovarian cancer and Ms. Smiley was being tested for a vitamin D deficiency.
The complaint alleges that PXDX is an “improper scheme designed to systematically, wrongfully and automatically deny its insureds medical payments owed to them under Cigna’s insurance policies.”
In March, Propublica investigated Cigna’s claims software, flagging discrepancies between a diagnosis and what Cigna considers “acceptable tests and procedures for those ailments.”
The study found that over two months in 2022, Cigna denied more than 300,000 claims, spending an average of 1.2 seconds on each. The suit alleges that the insurer does not have a “reasonable standard” for claims processing.
“PXDX is a simple tool to accelerate physician payments that has been grossly mischaracterized in the press. The facts speak for themselves, and we will continue to set the record straight,” a Cigna spokesperson told Forbes.
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