An amended complaint to a class-action lawsuit alleges that Cigna is improperly refusing to apply obligated discounts for medical services.
The complaint in U.S. District Court in Connecticut adds state law claims by the American Medical Association, the Medical Society of New Jersey and the Washington State Medical Association to the ERISA claims previously asserted by three individuals. Cigna's actions caused physicians to be underpaid and damaged the patient-physician relationship, according to the associations.
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The individual plaintiffs were enrolled in Cigna-administered health plans offered by their employers and received care from physicians who are part of the MultiPlan Network. As part of this network, these physicians agreed not to hold their patients liable for the difference between the original billed charges and the MultiPlan rate. However, the plaintiffs allege that Cigna frequently refuses to do so and instead pays a much lower rate, even though the physician has not agreed to accept that lower amount as payment in full.
"Patients and physicians have a right to expect health insurers to uphold their promise to provide fair and accurate payment for medical services," says Dr. Jack Resneck Jr., president of the American Medical Association. "But alleged misconduct by Cigna has allowed the insurer's economic self-interest to be prioritized ahead of their promises to physicians in the MultiPlan Network and their patients.
"The AMA and other physician organizations allege that Cigna's misconduct is riddled with conflicts of interest and manipulations that routinely shortchanged payments to MultiPlan Network physicians and interfered with the patient-physician relationship by ignoring the MultiPlan contracts and making incorrect statements to patients about their liability for the unpaid portion of the billed charges."
The association plaintiffs allege that Cigna is engaged in a deceptive business practice. Further, as explained in the amended complaint, "By ignoring the MultiPlan contracts and then lying on explanations of benefits to the insureds about their liability for the unpaid portion of the billed charges, Cigna, without justification or excuse, interferes with and undermines the professional and business relationship between patients and physicians."
"By joining Stewart v. Cigna as a plaintiff, the AMA hopes to shed light on Cigna's misconduct and create remedies so that patients and physicians can look forward to getting what they are promised," Resneck says.
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
