ProPublica Investigation of Commerical Health Insurance Industry Denial of Care Business Model Sparks National Outrage from Citizens
Media Update | By Kimberly Soenen
The investigation by ProPublica and The Capitol Forum that found Cigna doctors blocked payment for certain tests and procedures by automatically labeling them “not medically necessary” continues to bounce. (Full disclosure: This editor was a source.)
A key United States congressional committee asked commerical health insurance giant Cigna on Tuesday to provide corporate documents so that lawmakers can examine the company’s practice of denying health care claims without ever opening a patient file.
The House Committee on Energy and Commerce joined several state and federal regulators in scrutinizing the legality of Cigna rejecting the payment of certain claims using a system known as PXDX.
(Blood Money art installation for “SOME PEOPLE” (Every)Body by Michael John Curry.)
Denial of Care is the United States Commerical Health Insurance industry business model.
Read on:
“If these figures are at all illustrative of Cigna’s commercial appeal and reversal rates, it would suggest that the PXDX review process is leading to policyholders paying out-of-pocket for medical care that should be covered under their health insurance contract.”
-Rep. Cathy McMorris Rodgers wrote in a letter to Cigna
In two months last year, Cigna doctors refused to pay for more than 300,000 healthcare claims using the “PXDX” system. This system denies health need claims in batches of 50-100 every 1.2 seconds according to internal Cigna spreadsheets that tracked how fast the aglortihms and AI denied claims sight unseen.
The investigative feature was picked up by the PBS NewsHour and law firms nationwide. Federal data shows that commerical health insurance companies in the United States methodically denied more than 49 millions known claims in 2021, but customers appealed less than 0.2 percent of them.
Read the investigatve reporting feature here.