AABC Urges Cigna to Reconsider New AI Driven Reimbursement Policy
The American Association of Birth Centers (AABC) is raising serious concerns about Cigna’s recently announced policy, Evaluation and Management Coding and Accuracy Reimbursement Policy Number 49, which will automatically downcode high-level evaluation and management (E/M) claims using artificial intelligence (AI), without reviewing medical records. The policy is set to take effect October 1, 2025.
“This policy undermines accurate reimbursement, increases administrative burden, and ultimately threatens patient access to care,” said Kate Bauer, Executive Director, American Association of Birth Centers. “Providers deserve fair compensation for the complex, high-quality care they deliver. Patients deserve uninterrupted access to providers who are supported, not penalized, for the work they do.”
Under the new policy, high-level E/M claims (codes 99204–99205, 99214–99215, 99244–99245) would be automatically reduced by one level if flagged for “unspecified or improperly sequenced diagnosis codes.” AABC warns this will have multiple adverse effects:
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Inaccurate reimbursement: Complex cases requiring extensive time and clinical judgment will be underpaid without review of medical necessity.
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Administrative burden: Providers will be forced to file time-consuming appeals with full chart documentation, diverting resources from patient care.
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Threats to access: Revenue reductions could push providers—especially smaller practices in midwifery and primary care—out of network or out of practice entirely.
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Erosion of trust: Patients may lose confidence that their care is valued when insurers prioritize automation over clinical expertise.
AABC notes that similar AI-driven claims reduction policies, such as UnitedHealthcare’s emergency room policy, were ultimately abandoned due to impracticality and unfairness.
AABC is urging Cigna to revise the policy before implementation and ensure that any coding adjustments are based on a thorough review of medical records by qualified professionals, not automated processes.