Cigna uses algorithm to deny medical claims without doctor review
Cigna, one of the largest health insurers, used an algorithm called PXDX to automatically deny medical claims. The system flagged mismatches between diagnoses and procedures, and company doctors signed off on denials in batches without reviewing patient files. One patient, Nick van Terheyden, was denied coverage for a $350 vitamin D test that his doctor had ordered. Former employees said the system saved Cigna billions of dollars but left patients with unexpected bills.
- Date it happened
- 2021-09-01
- Organisation involved
- Cigna
- Product, system or model
- PXDX
This incident was imported from propublica.org. Our additions to it — the structured fields, the translation, the checks against other reports — are published under the same licence.
This is a record of what was reported, not a finding that anyone broke the law. If it names your organisation and you believe it is wrong, the corrections process is free and open to everyone.