[firm] blog logo

Out-of-Network Hospital Prevails in ERISA Claims Against Cigna

In the case of Connecticut General Life Insurance Company v. Humble Surgical Hospital, LLC, Cigna, as third-party administrator for various group health plans subject to ERISA (the ?Ç£Plans?Ç¥), sued Humble Surgical Hospital (?Ç£Humble?Ç¥), an out-of-network provider, to recover overpayments Cigna had allegedly paid to Humble as a result of Humble?ÇÖs ?Ç£fraudulent billing practices,?Ç¥ such as waiving patients?ÇÖ financial responsibility under the terms of the Plans. Prior to bringing its suit, Cigna had begun processing claims submitted by Humble outside of its standard claims processing model, based on Cigna?ÇÖs determination that such claims were fraudulent. This resulted in Cigna paying significantly less on Humble?ÇÖs claims than it would have paid if Cigna?ÇÖs standard out-of-network repricing methodology had been utilized. Consequently, Humble countersued Cigna under ERISA, based on its status as an assignee of the Plans participants?ÇÖ claims, seeking payment for underpaid claims as well as monetary penalties under ERISA for Cigna?ÇÖs… Continue Reading

June 2016
S M T W T F S
 1234
567891011
12131415161718
19202122232425
2627282930  

Archives