Like most insurers, Cigna Health and Life Insurance Company has contracts with certain entities who are its in-network providers. But it also has an agreement with a complementary entity called Multiplan, which is supposed to apply to payments to out-of-network providers who also participate with Multiplan. But the complaint alleges that Cigna does not pay the proper Multiplan rates to these out-of-network providers.
The class for this action is all California medical providers that did not have a contract with Cigna, but who did have a contract with Multiplan that provided medical services to patients with Cigna insurance cards bearing the Multiplan symbol, where the provider was underpaid by Cigna according to their Multiplan agreements.
Some of Cigna’s insureds have Multiplan logos on their Cigna insurance cards. The complaint alleges that Cigna puts this symbol only on the card of insureds who are eligible to receive Multiplan rates with out-of-network providers and that the “Multiplan logo is intended to and does represent to patients and out-of-network medical providers … that Cigna will apply the payment rates pursuant to the provider’s Multiplan agreement.”
The plaintiff in this case, Beach District Surgery Center, LP, had no agreement with Cigna and is outside of Cigna’s network, but it does have a Multiplan agreement. The complaint alleges, “Under [Beach District Surgery’s] Multiplan agreement, [Beach District Surgery] is to be paid 95% of any billed charges for any and all medical services it renders to patients with Cigna health insurance, less any co-payment, deductible, and/or co-insurance, if any.”
While it is possible for Multiplan or a provider to exclude certain insurance payors from using a Multiplan agreement, the complaint claims that Beach District Surgery did not have any such exclusions. The complaint also asserts that Multiplan never told Beach District Surgery of any limitation to the instances in which the Multiplan agreement applied.
Between 2019 and 2021, Beach District Surgery claims it has provided forty medical procedures to twenty-six patients who had insurance cards with both a Cigna symbol and a Multiplan symbol. However, the complaint alleges that Cigna did not make the payments required under the Multiplan agreements.
The complaint provides five instances of these medical procedure alleged underpayments. For example, on November 11, 2019, Beach District Surgery provided medical services for Patient 1. It then claims to have billed Cigna for $44,550, “with lengthy operative reports, chart notes, and other medical records.” Cigna processed the bill and made a payment of only $9,882.36, claiming in its Explanation of Benefits to have used Multiplan to figure this as the amount due to Beach District Surgery.
According to the complaint, Cigna has refused to pay any more on Beach District Surgery’s bills.
Article Type: LawsuitTopic: Insurance
Most Recent Case Event
Cigna Health and Life Insurance and Multiplan Underpayments Complaint
June 8, 2022
Like most insurers, Cigna Health and Life Insurance Company has contracts with certain entities who are its in-network providers. But it also has an agreement with a complementary entity called Multiplan, which is supposed to apply to payments to out-of-network providers who also participate with Multiplan. But the complaint alleges that Cigna does not pay the proper Multiplan rates to these out-of-network providers.
Cigna Health and Life Insurance and Multiplan Underpayments ComplaintCase Event History
Cigna Health and Life Insurance and Multiplan Underpayments Complaint
June 8, 2022
Like most insurers, Cigna Health and Life Insurance Company has contracts with certain entities who are its in-network providers. But it also has an agreement with a complementary entity called Multiplan, which is supposed to apply to payments to out-of-network providers who also participate with Multiplan. But the complaint alleges that Cigna does not pay the proper Multiplan rates to these out-of-network providers.
Cigna Health and Life Insurance and Multiplan Underpayments Complaint