How a massive healthcare giant automated the rejection of patient insurance claims

Cultures · Published 10 October 2026 Swipe more like this →

In short: The Cigna Group, a Fortune 500 healthcare leader, has faced intense scrutiny for its internal systems. Reports revealed a process called PXDX, which allowed company doctors to deny claims in bulk without reviewing patient files. This efficiency-focused strategy, internally dubbed click and close, highlights the tension between corporate profit and care.

Formed in 1982 through the combination of the Connecticut General Life Insurance Company and the INA Corporation, The Cigna Group has grown into a multinational insurance and healthcare powerhouse. Headquartered in Bloomfield, Connecticut, the company manages a vast network of providers, including over 550,000 physicians and hospitals within the United States. Despite its scale, the organization has frequently found itself at the center of controversy regarding its operational practices and treatment of policyholders.

The company's use of the PXDX system, identified in 2023, allowed medical staff to issue mass denials without examining individual patient records. This method prioritized speed, enabling doctors to reject claims with a single electronic signature. Such practices have contributed to the firm's reputation; the American Consumer Satisfaction Index listed Cigna among the most hated companies in the United States in both 2015 and 2018. These controversies extend to legal battles, including a 2020 Department of Justice lawsuit alleging the company defrauded government programs by submitting inaccurate diagnostic codes.

Public scrutiny intensified following the 2007 case of Nataline Sarkisyan, a teenager whose liver transplant coverage was initially denied by the insurer. Although the company eventually reversed its decision following public outcry, the incident sparked debates about the role of federal ERISA law in shielding insurance companies from liability. Beyond clinical disputes, the firm has navigated complex corporate maneuvers, including a failed 2017 merger with Anthem that resulted in a protracted legal battle in Delaware's Court of Chancery. Today, the organization continues to evolve, rebranding its health services portfolio as Evernorth and maintaining a global presence across Europe, Asia, and the Middle East.

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