**Cigna Faces Lawsuit Over Insurance Claims Algorithm**
Cigna, a major healthcare and insurance company, is facing a lawsuit that accuses the company of systematically rejecting claims using an algorithmic system. The lawsuit raises concerns about how technology could potentially harm patients as more healthcare organizations adopt AI and other new tools.
**Allegations of Systematic Claim Rejections**
The lawsuit, filed in California and seeking class action status, was initiated by two plaintiffs who were denied coverage by Cigna. One plaintiff, Suzanne Kisting-Leung, had an ultrasound referral due to a suspected risk of ovarian cancer. The other plaintiff, Ayesha Smiley, underwent testing for a vitamin D deficiency as advised by her doctor. The complaint alleges that Cigna utilizes an improper scheme to automatically deny medical payments owed to its policyholders.
**Claims Rejected Without Reviewing Medical Records**
According to a ProPublica investigation, Cigna’s software system relies on an algorithm that approves or denies claims in batches. The algorithm compares diagnoses with Cigna’s predefined acceptable tests and procedures for those ailments. In just two months, the company rejected over 300,000 claims, spending an average of 1.2 seconds on each claim. Although medical doctors gave their approval, the system did not require them to review patient medical records. This practice is alleged to violate California’s unfair competition laws and insurance code for failing to establish a reasonable standard for claims processing.
**The Intersection of Technology and Healthcare**
The rise of artificial intelligence and advanced technology has sparked discussions about the future of work across various industries, including healthcare. These technological advancements have the potential to benefit healthcare professionals by alleviating burdensome paperwork and assisting in diagnosing patients. However, concerns about patient privacy, access to care, and high medical costs also arise.
**Tech Adoption in the Healthcare Industry**
Cigna is not the only company leveraging technology to streamline processes. In April, Google’s cloud division introduced AI tools for healthcare claims processing. These tools utilize AI to organize data and enhance decision-making. Several companies, including Blue Shield of California and Bupa, have embraced this technology to improve their operations.
**The Law Firm Leading the Lawsuit**
Clarkson Law, a Malibu-based firm, represents the plaintiffs in this case against Cigna. The firm has previously taken legal action against tech giants in relation to their use of AI. In recent lawsuits, Clarkson Law accused OpenAI and Google of using unauthorized data, including the works of copyrighted artists and writers, to train and develop their AI products.
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