Cigna hit in August with another lawsuit over claims denials through PxDx

Cigna is facing another lawsuit over its PxDx tool, which has garnered controversy amid concerns that the insurer is using it to reject claims en masse.

The class-action suit was filed in late August in Connecticut federal court and alleges Cigna is using the tool to batch-deny claims knowing its members likely won't fight the decision.

"PxDx allows Cigna medical directors to automatically deny a claim purportedly on medical grounds without making a medically necessary determination or even opening the patient file, leaving patients with unexpected bills that should have been covered and paid," the plaintiff said in the suit. "Indeed, Cigna automatically denies claims because it knows that most patients will either pay such bills or forego the procedures, rather than deal with the hassle of appealing a denial."

Use of the PxDx tool first made headlines in March after a ProPublica article reported that across two months in 2022 about 300,000 claims were denied by Cigna using the tool.

Sources told the outlet that doctors spent an average of 1.2 seconds revewing each of those denials.

The lead plaintiff alleges that she had coverage for a colonoscopy and endoscopy denied by Cigna through PxDx. Those tests were critical to monitor her health given a Lynch syndrome diagnosis, which makes patients at a higher genetic disposition for certain cancers.

"Plaintiff has been financially damaged by Cigna’s practices, and her credit score lowered as a result of being automatically denied coverage for the preventative care that she desperately required," according to the lawsuit.

Cigna has maintained that the PxDx protocol is in line with industry standards, and, in a statement to Fierce Healthcare, noted that reviews through PxDx take place after a treatment has been provided, which does not deny patients care.

In addition, Cigna said the tool has been mischaracterized as being built on artificial intelligence and an algorithm, which it says is not the case. Only a specific list of services are reviewed through PxDx.

“This copycat suit is baseless and seems to erroneously assume that every claim goes through Cigna’s ‘Procedure to Diagnosis’ (also known as ‘PxDx’) review, when in reality, only a small subset of services do," a Cigna spokesperson said. "Based on our research, the claim in the complaint was not subject to Cigna’s PxDx review, and the complaint seems to be based on an article riddled with factual errors and misinformation."

The insurer was hit with a similar lawsuit in July, which was filed in California.