Healthcare System Sues Cigna Over Emergency Care Reimbursements
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Tenet Healthcare and nineteen of its hospitals filed a complaint against Cigna Health and Life Insurance Company in Connecticut Superior Court, alleging that Cigna had reimbursed its claims at unfair and unreasonable rates. The plaintiffs also allege that Cigna wrongfully denied claims for emergency medical services, although they are legally obligated to provide Cigna plan members with emergency medical care.
Cigna immediately removed the suit to Connecticut District Court, where it remains pending. The District Court has issued the standard scheduling orders for civil cases. Cigna has not yet filed its formal response to Tenet’s complaint.
In its complaint, Tenet claims Cigna reimburses its claims according to a unilateral payment methodology, resulting in steeply discounted payments. Tenet alleges that it did not agree to discounted payments, which bear no relation to the reasonable and fair value of the medical services provided to Cigna plan members. Tenet further alleges that Cigna has arbitrarily denied many claims of its members for emergency services rendered by Tenet and its hospitals.
As a result of its action, Tenet accuses Cigna of violating its common law right to payment for the fair and reasonable value of its services. It also claims that Cigna violated the legal obligation of health insurers to cover emergency medical services for its members and pay reimbursements in the amount of the fair market value of those services. Finally, Tenet alleges that Cigna violated the Connecticut Unfair Trade Practices Act.
Tenet claims that Cigna also refuses to add its hospitals to its roster of in-network providers, leaving plan members with no place to seek in-network non-emergent medical care in their geographical areas. According to Tenet, this refusal allows Cigna to continue unilaterally defining the level of reimbursement for services that Tenet provides to Cigna plan members.
Tenet’s complaint details allegations specific to various hospitals in different states, including Arizona, Florida, Tennessee, Alabama, Massachusetts, and South Carolina. Each hospital alleges state law claims and violations of the Emergency Medical Treatment and Labor Act (EMTALA).
Filed under: General Problems
I have Cigna.
Do you know they do not have an in-network ambulance? Any city I have lived in., NO.
Heads up when you get a $2000+ bill for 911. If you take the initiative to call you may get lucky and have it paid .. but don’t count on it. And be aware because if you don’t call you pay.