Texas Doctors Sue Cigna Over Payment Practices
Twenty-nine Texas doctors yesterday announced a lawsuit against Cigna Healthcare of Texas, alleging that the insurer has "intentionally and systematically" denied physicians payments to which they are contractually entitled, the Houston Chronicle reports. The lawsuit, which seeks class-action status, was filed last Thursday, the same day that state Attorney General John Cornyn (R) launched an investigation of the payment practices of Texas managed care organizations (Hughes, Houston Chronicle, 10/1). The lawsuit alleges that Cigna has:
- used its "large membership base to force" physicians into "one-sided and fundamentally unfair" contracts;
- "[a]rbitrarily" changed the procedures doctors must follow to obtain reimbursements, including "fail[ing] to recognize" procedural codes, thereby "resulting in a denial of payment";
- "[f]ail[ed] to pay the same amount in the same time period for the same procedure";
- failed to provide its fee schedule to doctors (Conklin, Dallas Morning News, 10/2); and
- engaged in "bundling," the practice of reimbursing for only one service when a doctor provides separate services (Houston Chronicle, 10/1).
The suit asks the court either to cancel the physicians' contracts with Cigna or to "require Cigna to pay contracted fees, when listed." If the contracts are canceled, the doctors want Cigna to pay them "full fees rather than rates negotiated in contracts" (Dallas Morning News, 10/1). Plaintiff's attorney Jim George said, "This is a case filed by physicians in response to years of frustration over Cigna's bureaucratic profits-over-patients mentality. It boils down to one specific idea: paying physicians for doing their job and paying them what they're entitled to." Cigna officials denied the charges. "While we have not seen a copy, we believe this suit is unwarranted. Cigna HealthCare has a strong commitment to delivering access to quality, affordable health care," the company said in a statement (Houston Chronicle, 10/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.