Cigna Healthcare uses an algorithm called PxDx to quickly deny claims. The algorithm allowed Cigna doctors to spend an average of 1.2 seconds on each claim.
https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
Cigna Healthcare uses an algorithm called PxDx to quickly deny claims. The algorithm allowed Cigna doctors to spend an average of 1.2 seconds on each claim.
https://www.propublica.org/article/cigna-pxdx-medical-health-insurance-rejection-claims
13 Comments
This appears to be just another example of how health insurance companies will look toward algorithms and AI to efficiently deny care in the future. It seems that the default policy is to deny, then hope that people either don’t bother to appeal or don’t have the time/resources to appeal.
I used to do consulting and one area of insurance that the company had was the claim process
Approval
Deny
Adjust
They hated the people doing it and they felt that was always the easiest place to cut costs.
I automated so many of these processes before AI to make the process smoother, so no shit they removed most of the entire process and just have AI do it. It’s crazy, cause a lot of this is subjective
Anecdotally, the number of claims I’ve had an initial rejection from Cigna has gone up by a lot this year. Not sure if it’s AI or because I moved country.
Yes but what is the CEOs name and where does he live?
I switched from Cigna this year, but for the one gray area “will they cover the better more expensive option the doctor is recommending” it took one email and about a week and they agreed to cover it.
Obviously anecdotal, and we were on one of their better plans as my wife was a teacher. Not sure how much of difference that makes.
Why we don’t want our health care to be in the hands of capitalism.
*slowly loads up “Another One Bites the Dust” on playlist…
Imagine if we were able to organize to the extent that we could get say 15%-20%+ of the country to drop their insurance, say on January 1st 2026? Would be amazing.
I had an Aetna claim basically denied after calling them to confirm it was fully covered. 5 hours of calls later they finally reversed it. I wonder how much that ended up costing them.
The algorithm:
if claim amount > 100
deny
else
deny
It seems that y’all have reached level 99 of fucking around, enjoy the finding out bit.
Slot machines in the UK are often programmed to pay out 85% to 90% of what they take. This is the Return to Player amount (RTP). I feel the US health insurance machines should be regulated with a %RTP that’s clearly displayed when people put their money in.
If insurance providers are going use algorithms and AI instead of human assessors to determine payouts then they are effectively running a casino and should be regulated as casinos.
So instead of using AI to revolutionize medicine or start diagnosis issues by sifting through data on the whole population they used it to cut time and cost on killing people by denying claims automagically? Yay capitalism is great.