Case Details for "Cigna "

Cigna Insureds May be Paying More for “Out-of-network” Health Care Providers than They Should

CIGNA INSUREDS MAY BE PAYING MORE FOR “OUT-OF-NETWORK” HEALTH CARE PROVIDERS THAN THEY SHOULD

            Cigna sells health insurance policies to individuals and employers.  Under these policies, Cigna has “in-network” and “out-of-network” health care providers (i.e., doctors, physical therapists, chiropractors, etc.).  Cigna has agreements with “in-network” providers under which Cigna’s payments to them settle the entire bill for Cigna insureds.  But Cigna has no such agreement with “out-of-network” providers.

            Cigna is supposed to pay the “usual, customary and reasonable” (“UCR”) rate to “out-of-network” providers, which is not necessarily their entire bill.  Insureds are responsible to pay the portion of the “out-of-network” provider’s bill Cigna does not cover.

            Cigna uses or has used databases created by Ingenix, Inc. to calculate the UCR rate Cigna would pay to “out-of-network” providers.  An investigation by the New York Attorney General revealed that Ingenix’s databases are intentionally skewed to lower the UCR rates, resulting in underpayments of as much as 10-28% by insurance companies, such as Cigna, that used Ingenix’s databases.  The difference was made up by insureds having to make higher out-of-pocket payments to “out-of-network” providers than they would have if true and accurate UCR rates were used by Cigna.

            Cigna agreed to resolve the New York Attorney General’s investigation of it by making a $10 million contribution to the development of a new database with accurate UCR rates and to stop using Ingenix databases.  However, this does nothing to reimburse Cigna insureds who have already paid more money out-of-pocket to “out-of-network” providers than they should have.

            Lawyers are investigating Cigna’s practices on behalf of insureds and would like to speak with people who believe they were harmed by Cigna.

Posted on:05/21/2009
Company: Cigna
Affected Class: Cigna health insurance customers who used out-of-network providers
Scope: Nationwide

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