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AMA, State Medical Societies Join Class Action Lawsuit Against Cigna

Analysis  |  By Jay Asser  
   September 13, 2022

The groups allege the health insurer underpaid claims submitted by patients for services covered through MultiPlan.

The American Medical Association (AMA), as well as the Medical Society of New Jersey and the Washington State Medical Association, have joined a class action lawsuit against Cigna alleging underpayments for claims through the MultiPlan network, the nations' largest third-party network.

Originally filed in June by Cigna members, the lawsuit takes issue with the health insurer's reimbursements at its non-participating providers rate instead of a rate for a MultiPlan contract when services were received from a participating provider. As such, Cigna members were "exposed to the threat of balance billing," the lawsuit states.

The plaintiffs argue that MultiPlan contracts prohibit providers from billing patients for the difference between the original charges and the discounted rates, which Cigna is responsible for.

They claim the payer "also breached its fiduciary duties, including its duty to honor written plan terms and its duty of loyalty, because its conduct serves Cigna's own economic self-interest and elevates Cigna's interests above the interests of plan member patients."

AMA president Jack Resneck Jr. criticized Cigna for prioritizing its "economic self-interest" above its commitment to physicians and patients in the MultiPlan Network.

"The AMA and other physician organizations allege that Cigna's misconduct is riddled with conflicts of interest and manipulations that routinely shortchanged payments to MultiPlan Network physicians and interfered with the patient-physician relationship by ignoring the MultiPlan contracts and making incorrect statements to patients about their liability for the unpaid portion of the billed charges," Resneck said in a statement.

"By joining Stewart v. Cigna as a plaintiff, the AMA hopes to shed light on Cigna's misconduct and create remedies so that patients and physicians can look forward to getting what they are promised."

Jay Asser is an associate editor for HealthLeaders.

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