Why Cigna's review process worries 1 spine surgeon


A recent Pro Publica report revealed how some Cigna Health physicians reject patient claims without opening their files, something that concerns spine surgeon Saqib Hasan, MD.

According to internal documents obtained by ProPublica, more than 300,000 requests for payments using Cigna's PXDX review process were denied over a two-month period in 2022, the March 25 report said. Cigna physicians spent an average 1.2 seconds on each case.

Dr. Hasan, of Walnut Creek, Calif.-based Golden State Orthopedics and Spine, said he felt PXDX was another roadblock to getting patients their care. 

"Cigna has been notorious for essentially drowning surgeons in paperwork in the hopes that we can't finish our peer-to-peer reviews in a timely manner, essentially delaying patient care," Dr. Hasan told Becker's. "They will do whatever they can to put a cog in the wheel of healthcare delivery."

Dr. Hasan said he's had difficulty with Cigna in the past. In a recent situation, he told Becker's a patient who needed a corpectomy had the case delayed over the insurer "nitpicking over a few billing codes."

A Cigna spokesperson disputed ProPublica's narrative, saying the report was a "mischaracterization of [the] process" and doesn't create impediments to care since it takes place after a patient receives services. 

"PxDx allows us to automatically pay providers for claims that are submitted with the correct diagnosis codes, and prioritizes our medical directors' time for more complex reviews," the spokesperson said in an April 4 email to Becker's.

Dr. Hasan said one way to solve these rifts would be to have an independent entity that patients and physicians can go to that isn't run by the insurer.

"If the [insurer] runs any kind of appeal process there's inherent bias because their bottom line and allegiance will always be to their shareholders, not their patients," Dr. Hasan said.

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