Major health insurance companies have stopped using humans to review insurance claims, and they are now just using computer algorithms to deny claims for millions of American patients. Mike Papantonio & Farron Cousins discuss more.


*This transcript was generated by a third-party transcription software company, so please excuse any typos.

Mike Papantonio: Major health insurance companies have stopped using humans, I can’t make this story up, they’re not using humans to review insurance claims and they’re now using computer algorithms to deny claims when a person has to have surgery or when a person needs medication or when a person needs physical therapy. They’re using computers to say, no, you can’t have that heart surgery. Right?

Farron Cousins: Yeah. This is a terrifying story. And this is, you know, ProPublica did a wonderful job as they always do.

Mike Papantonio: Yeah.

Farron Cousins: One of the last few truly independent journalism places.

Mike Papantonio: Love that site, man.

Farron Cousins: But they have found that, Cigna is one of the worst offenders, but it’s happening across the board. And what Cigna did is they started to use a program called PXDX that was developed by a doctor who now is making boo koo cash from insurance companies. And what it does is it flags any claim that has something that this particular doctor thinks shouldn’t be a treatment or a test with that particular illness. And therefore the claims are immediately denied. These doctors, or excuse me, these insurance executives are now able to deny hundreds of claims per minute instead of spending an hour or so on each claim.

Mike Papantonio: Okay. They’re using, okay, like the doctor that is making a decision about whether or not you get heart surgery, because you had a heart attack and the doc says you really need heart surgery, the doctor who’s making that decision is a podiatrist. Okay. He’s a foot doctor and he’s making the decision based on what comes out of that algorithm in the computer that says, no, we can’t give this guy heart surgery. If he does, he’s gonna have to pay for it. And Cigna has gotten away with it. All of these insurance companies are doing that. And Congress knows this. Congress knows that this is the biggest scam. The idea, here’s what, here’s the idea of it. Deny, deny, deny benefits and maybe people will just go away. Maybe they won’t actually do anything about it. Right?

Farron Cousins: Yeah. Because they have it built into their system like so many other corporations, we know that if we deny 100 claims only on average five of those claims, the people will actually challenge. So 95%, that’s their number, 95% get that letter saying we’re not gonna cover it and they just accept it and they go on with their lives and they get this massive medical debt. But they say, there’s nothing I can do. My claim has been denied. Only 5% of people will say, well, hold up. My doctor diagnosed me with this and said I need this test. Yes, it’s cancer. But they said, I have to have the ultrasound because they wanna see if it is spread over here.

Mike Papantonio: Let’s call out names. These are names, doctors that were working with Cigna, Dr. Dopke. Okay. Dr. Dopke, he rejected 121,000 claims based on the computer algorithm. Dr. Richard Capek, he denied 80,000 claims that came out of the computer. Clear denials. Now that’s during a two month period of time. That’s two months. Dr. Rossi, denied 63,000 claims that came out of the computer. Well, here’s what I’m going to do, just so you know, let me land this story. We are now gonna start bringing lawsuits against the doctors who make these decisions because in the chain of events they’re committing malpractice. Okay. When you have a podiatrist that’s making a decision that a person can’t get heart surgery, you do the math on that. It’s just a matter of time. We’re gonna find the perfect case and we’re, it’s gonna be very public. We’re looking for it right now.

Farron Cousins: Yeah. And for the record, the doctor that created this PXDX, Dr. Alan Muney. Alan Muney is the guy that created this.

Mike Papantonio: Yeah.

Mike Papantonio is an American attorney and television and radio talk show host. He is past president of The National Trial Lawyers, the most prestigious trial lawyer association in America; and is one of the few living attorneys inducted into the Trial Lawyer Hall of Fame. He hosts the international television show "America's Lawyer"; and co-hosts Ring of Fire Radio, a nationally syndicated weekly radio program, with Robert F. Kennedy, Jr. and Sam Seder.