Cigna Algorithm Lawsuit: The Auto-Denied Health Claims

What the Lawsuit Alleges

Following a 2023 investigative report, a class action accused Cigna of using an automated system called PXDX (procedure-to-diagnosis) to reject health-insurance claims in bulk without the individual physician review that law and policy require. The suit alleged the system denied more than 300,000 claims over a two-month period, with Cigna doctors spending an average of about 1.2 seconds “reviewing” each one before signing off on batches of denials.

The core claim is that this batch, rules-based denial evades the “thorough, fair and objective” investigation that California law requires for each claim.

The Status

Cigna sought to dismiss the case, but in 2025 a federal court in California allowed the class action to proceed — a notable ruling, because it lets plaintiffs test in discovery how the algorithm actually worked. The case is part of a broader wave of scrutiny of automated and AI-driven claim decisions by health insurers.

These remain allegations; Cigna disputes that PXDX improperly denied valid claims.

What Patients Should Know

If a health claim is denied, you have appeal rights — internal appeals and, often, an external independent review — and a striking share of denials are overturned when actually reviewed. Keeping the denial letter, your policy and the medical documentation is what makes an appeal effective, whatever a bulk algorithm decided first.