Over a period of two months last year, Cigna doctors denied over 300,000 requests for payments using this method, spending an average of 1.2 seconds on each case, the documents show. [...] Medical directors do not see any patient records or put their medical judgment to use, said former company employees familiar with the system. Instead, a computer does the work. A Cigna algorithm flags mismatches between diagnoses and what the company considers acceptable tests and procedures for those ailments. Company doctors then sign off on the denials in batches [...] “We literally click and submit,” one former Cigna doctor said. “It takes all of 10 seconds to do 50 at a time.”
PXDX flags a mismatch between a diagnosis and the tests Cigna considers acceptable for it, and a medical director signs the denials off in batches without opening a file. Over two months in 2022 that was more than 300,000 refusals at an average of 1.2 seconds each. Cigna told ProPublica the description was incorrect and declined to answer further questions. It is on this page for the same reason the Dutch benefits scandal and Michigan's MiDAS are: to the person receiving the letter there is no difference between a model and a matching rule, and the harm comes from the same design decision in all three, which is removing the human read while keeping the human signature. The medical director's name is on every one of those 300,000, which is what makes them lawful. Cigna is now defending a class action over it, alongside the UnitedHealth case elsewhere on this page.
