Cigna, Viant Conspiracy to Negotiate Insurance Payments Class Action

Behavioral health problems, such as drug or alcohol addiction, can be difficult and expensive to treat. In this class action, the complaint alleges that Cigna Behavioral Health, Inc. and Viant, Inc. have “systematically undervalued and underpaid” claims, requiring insureds to pay excessive out-of-pocket charges.

The class for this action is any member of a health benefit plan either administered or insured by Cigna whose claims for out-of-network behavioral health treatment, including mental health or substance use disorders, were either underpaid or repriced by Cigna and Viant.

The plaintiff in this case, identified as RJ, had health insurance via her employer that also covered her son, identified as SJ. The insurance was administered by Cigna. The complaint alleges, “Cigna charges higher premiums for plans like [RJ’s] that give members the freedom to choose their own healthcare providers, including those outside of Cigna’s ‘network.’” The complaint alleges that Cigna instead “punish[ed] them” for choosing out-of-network providers.

SJ needed treatment for behavioral health disorders, including for substance use. The policy was supposed to cover such treatments at usual, customary or reasonable (UCR) rates.

But the complaint alleges that the companies colluded to withhold and underpay RJ’s claims for her son’s treatment, via “a dishonest and self-serving reimbursement scheme. Specifically, Cigna, without [RJ’s] consent or authority, contracted with Viant to ‘negotiate’ the amounts that Cigna would ultimately pay for [RJ’s] out-of-network claims.” Their collusion, the complaint says, created “impenetrable, systemic, administrative barriers to circumvent rights protected by federal laws.”

According to the complaint, the collusion resulted in insureds having to pay the difference between what Cigna should have paid and what it arranged with Viant that it would pay. The difference “often ran into the tens, and sometimes hundreds, of thousands per patient…”

What were the roles of the two companies? Cigna “issued, underwrote, and/or administered” the plan and was responsible for paying the insureds’ claims. The complaint claims, however, that Cigna does not use the proper methodologies to calculate UCR rates. “Instead, Cigna contracts with Viant to ‘negotiate’ reimbursement rates with providers.” According to the complaint, Viant is a third party that had no authorization to determine payments.

The complaint makes reference to an earlier case involving a company called Ingenix: “In that scam, insurers like Cigna contracted with Ingenix, using their systems and databases, to determine reimbursement rates that were found to be well below UCR and used deeply flawed methodologies.” That case resulted in a $350 million dollar settlement for underpaid claims. “It also required insurers to finance an objective database of reimbursements … which patients and insurers nationally could rely on.” However, it did not require the insurers to use it.

Article Type: Lawsuit
Topic: Insurance, RICO

Most Recent Case Event

Cigna, Viant Conspiracy to Negotiate Insurance Payments Complaint

April 2, 2020

Behavioral health problems, such as drug or alcohol addiction, can be difficult and expensive to treat. In this class action, the complaint alleges that Cigna Behavioral Health, Inc. and Viant, Inc. have “systematically undervalued and underpaid” claims, requiring insureds to pay excessive out-of-pocket charges.

Cigna, Viant Conspiracy to Negotiate Insurance Payments Complaint

Case Event History

Cigna, Viant Conspiracy to Negotiate Insurance Payments Complaint

April 2, 2020

Behavioral health problems, such as drug or alcohol addiction, can be difficult and expensive to treat. In this class action, the complaint alleges that Cigna Behavioral Health, Inc. and Viant, Inc. have “systematically undervalued and underpaid” claims, requiring insureds to pay excessive out-of-pocket charges.

Cigna, Viant Conspiracy to Negotiate Insurance Payments Complaint
Tags: Health Insurance, Incomplete payment of benefits due, Insurance, RICO laws