Cigna, a major health insurance company, is under fire as a recent lawsuit alleges that the company has been employing artificial intelligence (AI) algorithms to deny numerous health insurance claims unfairly. The lawsuit was filed in California by two Cigna health plan members and their legal representatives.
According to the complaint, Cigna is accused of sidestepping required individual claim reviews by relying on an AI system known as PxDx. This system reportedly rapidly denies medically necessary claims, with an astonishing average processing time of just 1.2 seconds. By doing so, the company denies patients access to vital medical tests and treatments, leaving them to bear the financial burden themselves.
The lawsuit claims that Cigna’s use of AI violates state insurance regulations as proper and unbiased claim reviews are not being conducted. Cigna, on the other hand, defends its use of AI, arguing that it aids in verifying billing codes and facilitates faster payments to doctors.
The plaintiffs’ legal team is seeking a jury trial and hopes to have the case certified as a federal class action, potentially representing the two million Cigna health plan members in California.
Although legal experts anticipate challenges for the plaintiffs in winning the class action, they also believe that the case may put pressure on Cigna to reach a settlement if it proceeds as a class action.
This lawsuit highlights the growing concern surrounding the role of AI in healthcare decision-making and interactions. Moreover, it follows an investigation by ProPublica, which previously exposed claim denial issues involving other physicians at Cigna.
Notably, Cigna has faced legal issues in the past, including accusations of underpaying medical claims and engaging in conspiracies to raise prescription drug prices.
As the lawsuit progresses, Cigna is expected to contest the class size in court, while the plaintiffs strive to include all affected health plan members in California.
The case brings attention to broader worries about the potential displacement of humans in various industries, particularly healthcare and business, as AI continues to advance. Clarkson, a public advocacy law firm representing the plaintiffs, has a history of taking legal action against tech giants, such as Google and OpenAI, the creator of ChatGPT, over allegations of using personal and professional data of internet users to train AI systems.