Search
Categories
Archive
- August 2020
- March 2020
- January 2020
- July 2019
- January 2019
- November 2018
- October 2018
- September 2018
- February 2018
- November 2017
- August 2017
- July 2017
- March 2017
- December 2016
- July 2016
- June 2016
- May 2016
- February 2016
- January 2016
- December 2015
- November 2015
- October 2015
- August 2015
- July 2015
- May 2015
- April 2015
- March 2015
- February 2015
- January 2015
- December 2014
- November 2014
- October 2014
- September 2014
- July 2014
- May 2014
- April 2014
- March 2014
- February 2014
- December 2013
- November 2013
- October 2013
- September 2013
- August 2013
- July 2013
- June 2013
- May 2013
- March 2013
- February 2013
- January 2013
- December 2012
- November 2012
- October 2012
- September 2012
- August 2012
- July 2012
- June 2012
- May 2012
- April 2012
- March 2012
- February 2012
- January 2012
- November 2011
- October 2011
- June 2011
- March 2011
Popular Posts
- UnitedHealthcare Class Action-UHC Sued for Overpayment Offsets in Violation of ERISA and for Misleading Patients and Plan Sponsors
July 11, 2014 Aetna Class Action-Aetna Sued for Overpayment Offsets in Violation of ERISA and for “Illegal Self Help” Designed to Circumvent ERISA
October 29, 2014Cigna ERISA Lawsuit-Cigna Loses In Federal Appeals Court to Out-of-Network Providers & Patients
March 11, 2015
- UnitedHealthcare Class Action-UHC Sued for Overpayment Offsets in Violation of ERISA and for Misleading Patients and Plan Sponsors
This is not surprising for Cigna. I have had many issues with them concerning my personal health care choices. They are a huge company who does not care about their clients. This is a great ruling. It’s about tone someone stood up for the patient.
Charlotte p.-Thanks for reading. I appreciate your comments
All insurance companies are like this. This is why companies like mine exist. To keep the patient responsibility as low as possible. If they just paid like the plan said none of this would be an issue. But insurance companies are business oriented, no matter how much they claim other wise through advertisement. Networkpluscollections.com
Kendra-Thanks for your comments. I agree with you they should have just paid according to the terms of the plan.
We are looking for an attorney familiar with these type of issues and possibly substance abuse facilities. We are a reputable, almost Joint Commission Accredited (in process)facility. We are out of network with all ins companies.Cigna issues 🙂
Comments thus far indicate a common misconception about ERISA plans. CIGNA was merely the administrator paying for claims from the employers general funds at the direction of the employer’s plan document. Any funds not spent on these over priced out of network claims remained with the employer’s general fund, not CIGNA. Most of these non network providers charge an egregious amount which ultimately increases the cost of the program. In Texas, provider’s business strategies often include charging for services at a rate many times greater than any prudent benchmark or network contracted rate. Thus allowing them to enrich themselves by waiving member liability and receiving a much larger reimbursement that otherwise would be possible, even after waiving the member responsibility. How affordable will the employee contributions be when the amount these non network providers charge is 400% or more higher than the average?
C. Carter-Thanks for taking to the time to reply. I agree that the TPA is merely supposed to pay the claims at the direction of the plan documents. However, since this case was decided there have been over 100 Cigna administered plans sued for “embezzlement” of health plan assets. It would appear, based on the allegations made in the lawsuits, that Cigna did indeed keep the funds not spent on “overpriced out of network claims”. IMHO, this practice is prevalent across the industry. I would estimate that this practice alone, accounts for more than 50% of all self insured health plan expenditures being siphoned off or diverted, and court documents have shown that in some cases it is as high as 90%!
Interesting Article. Thank you. In my experience it appears that insurance companies are in business to make money and they are very good at making money. The insurance companies have grown to be the dictator of our healthcare system and they are so strong that they greatly impact small & large US businesses ability to be competitive in the world market. Why is it not obvious that patients and providers are being victimized by the might of insurance companies. This ruling at least may help us regain some control over the care provided that we pay for.
How do you submit a complaint. Cigna approved a Neurosurgeon and Neurosurgical as in-network because there wasn’t a Neurosurgical or Neurosurgeon in their network. They paid 100% of my first few visits, and approved my surgery for cervical fusions, after my surgery they only paid, 60% out of network rate. There was one charge for $237.00 that wasn’t paid at all due to procedure not typically charged. Which was fine, I could pay $237.00. When I received the EOB and looked at Medical Claim Detail I saw they paid in full but ONLY OUT OF NETWORK. First of all, I didn’t receive a bill from Neurosurgeon and office until 7 months after my surgery. And when I called Cigna a customer service Rep said they’d take care of it and not to worry. I called approximately 10 times to follow-up, each rep gave me the same answer. It wasn’t till the very last call, that I got an answer.. well we can’t pay asst surgeon same billing codes as surgeon. But they did, just out-of-network amount. The only charge they refused was $237.00. I told them it’s right there in writing. Then Amanda asked if I could fax her what I had??? It came FROM THEM. The surgeons office didn’t help at all.. they kept saying most insurance companies won’t pay BUT THEY DID! I kept asking and finally telling everyone to LOOK AT THE STATEMENTS, APPROVALS AND HOW THEY WERE PAID OUT-OF-NETWORK! My gosh! They waited till the last moment to where the time limit was up. I feel like since my plan had ended the year after the surgery which was in December they didn’t care anymore and pushed it off till the last minute so they wouldn’t have to pay. Even so, the last call with Amanda who gave me hr personal fax helped, she sounded like she cared. Not one call back after my fax after faxing her many requests to call me. I then received a collection notice from an agency. The amount was too big. The doctor office said I could set up payment plan.. I’m on disability and I was told I could make small payments. When I went to the billing manager told me no less than $250.. her remark was “you weren’t on disability at the time of surgery.” But I was just not on SS at the time.. LTD. And I had to wait 5 months till it kicked in. I feel if Cigna just paid the claims correctly and had fixed the issue I brought up 10+ times.. I wouldn’t be here right now.. in collections. The neurosurgeon is considered the best in Alaska and I can’t go back to see him with other problems I have because of his back office and Cigna… I feel helpless.. I’m on Disability and I can only focus for so long.. I tried so hard.. I need this to go away but I can’t afford an attorney.. plus I have so much I need to address in EVERY ASPECT OF MY LIFE, I CAN’T CATCH UP.