Eyewitness News 11am from 11:38 to 11:43 in US/Central

- Today on "InvestigateTV+," insurance companies accused of using tech to deny thousands of claims in just seconds, I'm Lee Zurik. - And I'm Tisha Powell, we investigate one major insurer's process, and its possible impact on families across the country. - This is not a computer issue, I'm a human, I'm having human issues. (air whooshing) - [Lee] Plus, social security recipients learn they've been overpaid, and they are potentially on the hook for thousands of dollars. - The scary part of this is, is I'm just one step away from being homeless. - [Lee] We go in depth to find out why it's happening to millions of people. - We have stories going back 35, 40 years, people are just terrorized. (air whooshing) - [Tisha] And a passion for a school pantry inspires others to support students in need. - Everybody Knows Miss Darga and loves Miss Darga, and she is just like the heart and soul of our school and our community - In-depth stories that inform and inspire. You're watching "InvestigateTV+." (upbeat music) (air whooshing) - A lawsuit filed in 2023 claims a major insurance company used a computer program to deny some claims in less time than it took me to say this sentence. - Yeah, the insurance industry has long touted technology in using an electronic system as the solutions to high medical costs, and slow claims processing. But we found accusations that it's not always working to patients' benefit. (air whooshing) - This is personal (chuckles), you know, like this is really hard. - [Lee] A very personal story of building a family turned into what Amanda Bredlow says, "Started to feel like a cruel game," where insurance denials felt anything but personal. - I was getting turned on this very convoluted pinball machine of a path that didn't end up getting anywhere. - [Lee] In January of 2020, Amanda and her husband, like many couples, decided they needed to turn to medical professionals to conceive a second child. It would be expensive, but they found a plan. - We saw that this policy covered infertility treatments, and we wanted to take advantage of that. - [Lee] But quickly they started facing problems using the coverage. - We started doing the treatments, and then we started noticing that we were getting denied. - [Lee] Each time she says they'd file, they'd be sent a letter, told the filing was a duplicate and invalid. And at least once the exact medical treatment code listed as covered in the couple's policy apparently didn't apply, and no person she talked to, it seemed, could help her. - The reasons were very vaguely worded, it was like, "This is not in accordance to our policy," or something like that. - [Lee] Then the couple saw an article by ProPublica, an article that claims Cigna employed doctors were signing off on rejections without even reading the files, denying some claims at an average rate of one every 1.2 seconds. - My husband just had like a light bulb aha moment, like this must be what's happening to us. - [Lee] In California, attorneys who work with clients and consumer issues also saw the same story, and investigated further. Now, they're representing a client suing Cigna, and plan to pick up more through class action. The lawsuit accuses Cigna of using a computer algorithm to systematically deny claims in bulk without proper review by a doctor, something the attorneys on this case say is illegal under state law, and potentially against federal insurance regulations. - They're supposed to use doctors to open up the patient files and examine the claim, examine the patient's history, complications, et cetera, to then use their expertise to determine whether that claim is medically necessary, whether that procedure was medically necessary. And Cigna is not always doing that. - Instead, attorneys explain to us there's a system called procedure to diagnosis, PxDx. It's a computer program that matches patient procedures with a diagnosis code. If the two don't match what the policy considers medically necessary, the computer denies the claim. An attorneys claim a doctor just rubber stamps that denial without a real review. In some cases, people weren't reimbursed, and others they may not have gotten necessary treatment. In two months, 300,000 claims denied. Cigna wouldn't talk to us for this story, but published a rebuttal to criticisms online stating that its PxDx program was only used in a small group of inexpensive procedures, that 94% of claims in that system were approved, and that it has successfully helped us accelerate payments to physicians for tests and treatments. Our investigation found Cigna isn't the only company accused of issues with claims