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Patrick Rucker, Maya Miller and David Armstrong
A key congressional committee asked insurance giant Cigna on Tuesday <5/16/23> 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.
Rep. Cathy McMorris Rodgers, a Republican from Washington who chairs the committee, noted that policyholders under Cigna’s Medicare Advantage plans appeal about one in five denials for requests for medical procedures, known as prior authorizations. Of those denials, about 80% are overturned.
“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,” Rodgers wrote in a letter to Cigna.
The letter follows an 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.”
In two months last year, Cigna doctors refused to pay for 300,000 claims using the PXDX system, spending an average of 1.2 seconds on each case, according to spreadsheets that tracked how fast they worked.
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