Cigna sued over COVID-19 treatment, testing payment

Dive Brief:

  • Cigna is facing a lawsuit arguing it failed to pay a New Jersey medical office for COVID-19 diagnostic testing and treatment, according to a complaint filed this week in federal court.
  • The medical office, Open MRI and Imaging of RP Vestibular Diagnostics, alleges it is owed nearly $400,000 from Cigna, which it says has arbitrarily refused to make payment in violation of the Coronavirus Aid, Relief, and Economic Security Act.
  • Cigna declined to comment on the lawsuit. The medical office claims payment was denied for services rendered between February and July.

Dive Insight:

It’s unclear whether the New Jersey medical office that brought the lawsuit is in network with Cigna, but Congress tried to account for potential out-of-network issues that can lead to surprise bills when it drafted the CARES Act. The law, enacted in March, requires plans to reimburse COVID-19 testing and treatment based on the negotiated rate, or the cash price listed online for the service if an agreement was not in place before this public health emergency.

The CARES Act also requires insurers to cover the testing without any prior authorization requirements or imposing cost-sharing on patients.

There are some wrinkles in the potential implementation of that mandate, though.

An earlier Health Affairs report raised concerns that the guidance “does not include, say, timelines for posting cash prices or any indication of whether these requirements extend beyond diagnostic labs to the individual providers that administer the COVID-19 test.”

Many of the nation’s largest insurers have raked in eye-catching profits as the coronavirus pandemic has fanned out across the country at an alarming rate, sickening millions and causing many to delay care either voluntarily or due to mandated orders from state and local governments.

In light of those staggering numbers, many insurers have sought to increase benefits or waive out-of-pocket costs for certain procedures or doctor visits. The payer lobby has sought to publicize those efforts as it seeks to avoid pushback for profiting from the pandemic.

Still, a Congressional committee said it is launching an inquiry into health insurers following the financial results from the second quarter.

Experts caution, though, that there is still a long road ahead and that insurers may find that the tables turn when more patients — and potentially sicker patients — return in large shares.

Posted in Law

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