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Federal District Court in Texas Rules on Cigna?ÇÖs ?Ç£Fee Forgiveness?Ç¥ Protocol in the Administration of Medical Benefit Claims

The U.S. District Court for the Southern District of Texas recently ruled on motions for summary judgment by both parties in North Cypress Medical Center Operating Company, Ltd v. Cigna Healthcare, holding that Cigna?ÇÖs application of its ?Ç£fee forgiveness?Ç¥ protocol (the ?Ç£Protocol?Ç¥) in the administration of benefit claims for medical services rendered by North Cypress was legally incorrect and constituted an ?Ç£abuse of discretion?Ç¥ under ERISA. ?áCigna performed claims administration services as a third-party service provider for employer-sponsored, self-funded group medical plans and as the insurer under employer-sponsored, fully-insured group medical plans (collectively, the ?Ç£Plans?Ç¥). ?áNorth Cypress was an out-of-network healthcare services provider (an ?Ç£OON Provider?Ç¥) that offered to waive or discount patients?ÇÖ cost-sharing obligations in exchange for prompt payment for its billed services. ?áWhen North Cypress submitted the patients?ÇÖ benefit claims to Cigna, Cigna applied the Protocol, which significantly reduced or denied the claim payments to North Cypress based… Continue Reading

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