AI Denial Lawsuits: UnitedHealth and Cigna in Court. What It Means for Patients.

Federal lawsuits filed in 2023 and 2024 allege that major health insurers used artificial intelligence systems to deny claims at rates and speeds that could not reflect individualized medical review. The cases against UnitedHealth Group and Cigna have drawn attention to the use of algorithmic decision-making in health insurance, and they may affect how AI-driven denials are regulated going forward.

If you have been denied coverage and suspect that an automated system made the decision, understanding what these lawsuits allege and what they might mean for patient rights can help you evaluate your own situation.

What the Lawsuits Allege

The most prominent case is a class action lawsuit filed against UnitedHealth Group in November 2023, alleging that the company used an AI model called nH Predict to systematically deny post-acute care claims for Medicare Advantage beneficiaries. According to the complaint, nH Predict generated discharge timelines that contradicted individual patient circumstances and physician assessments, leading to inappropriate claim denials.

A separate class action lawsuit filed against Cigna in March 2024 alleges that the company used an internal system called PxDx to mass-deny prior authorization requests without individual medical review. The lawsuit cites internal data suggesting that Cigna physicians were rejecting hundreds of requests per hour, spending an average of seconds per case.

Ellen can help you understand AI-driven denials and build appeals that address algorithmic decision-making. Start here →