Major healthcare provide, Cigna is facing a massive lawsuit. California requires “a thorough, fair and objective investigation and shall not persist in seeking information not reasonably required for or material to the resolution of a claim dispute.” Instead, the lawsuit claims Cigna used software to deny insurance claims automatically. Cigna claims they only did this in rare circumstances, and yet during 2 months last year, the numbers were over 300,000 claims from their 18 million insured. With only one visit to the doctor a year, that’s 10% of the doctors visits. But we know that some people go more often than that, and some less. This isn’t even AI, but a simple sort filter that just kicks out the selected requests.
Cigna has been sued in California based on allegations the US healthcare insurer unlawfully reviewed insurance claims using automated systems rather than relying on humans.