By: Karina Gonzalez
Cigna filed a multimillion-dollar federal lawsuit against 11 Indiana based Ambulatory Surgical Centers for billing fraud in allegedly failing to collect out-of-network cost share obligations from customers. In line with Cigna’s ongoing practice, it stopped paying the Center’s claims and demanded return of monies paid and filed an injunction against the Centers to halt fee-forgiving models in the future. Cigna’s definition of fee forgiveness involves a provider accepting an insurer’s payment and then waving in full or in part the cost share obligations of its customers. Cigna will deny the entire bill, or will claim it made an overpayment and demand return of all monies paid. It consistently leaps to the conclusion that if the patient did not pay his/her responsibility or was not billed for it then there is no insurance coverage and essentially no payment will be coming from Cigna to the provider. This is exactly the situation that many Florida out-of-network providers are facing when they provider services to Cigna customers.
Is Cigna applying this same inquiry to its in-network providers who may also waive or forgive a co-payment or deductible because a patient is unable to pay? Many out-of-network providers are voicing objections because they have no contractual relationship yet Cigna’ believes that it has unilateral authority to enforce a contractual requirement against them. Although Florida has enacted a prohibition on waiver of co-payments and deductibles it does not support Cigna’s ongoing practice of denying all payment and providing no coverage for the service for what it terms as a practice of fee-forgiveness.