Special E-Mail Bulletin #2
October 2001
Disputed Reimbursement Lawsuit vs CIGNA Texas
Special E-Mail Bulletin #2
Hi, everyone.
Here's an interesting story from the October 22 issue of AMNews. It's about the emerging trend of providers banding together to challenge healthplans over payment disputes. This one is another effort seeing class-action certification. What makes this Texas case unique is the contention -- that CIGNA "stole" services from the physicians and violated that state's "Theft Liability Act."
It will be interesting to see if this approach is successful.
Gil Weber
Texas doctors sue CIGNA over service "theft"
Doctors' claim filed in state court accuses the insurer of stealing their medical services. The firm says the complaint is unwarranted.
By Tanya Albert, AMNews staff. Oct. 22/29, 2001.
Nearly 30 Texas physicians filed a lawsuit against CIGNA Healthcare of Texas Inc., earlier this month, saying they're fed up with the way the insurance company has treated them and frustrated that discussions haven't resulted in changes.
The lawsuit accuses the company of breach of contract and breach of good faith and fair dealing. And using a unique tactic, the lawsuit also claims that CIGNA violated the Texas Theft Liability Act by stealing their services. They say the thefts occurred when the company didn't pay them for care they provided to CIGNA patients.
"Our goal is very simple," said Robert J. Provan, one of the attorneys representing the physicians. "It is to see that Texas doctors are paid for their services. ... The purpose of this lawsuit is to save the medical practices of thousands of Texas physicians who are being pushed to the edge of financial ruin by a company that refuses to pay its debts."
The complaint, filed in the District Court of Travis County, asks for class action certification. It is one of a growing number of lawsuits that physicians have filed in state courts against large health insurance companies.
Physicians in Connecticut, Illinois and New York have filed similar suits in their states. Connecticut physicians earlier this year received class action certification for their suit against Anthem Blue Cross Blue Shield of Connecticut, in which all physicians in the state will be plaintiffs. A state court judge in Illinois has ruled that a case against CIGNA filed there will be expanded to include physicians nationwide. Lawsuits seeking class action status also are pending in federal court in Miami.
Last resort
Arlington, Texas, general and vascular surgeon Bohn D. Allen, MD, one of the plaintiffs in the Texas suit, called the lawsuit a last resort after years of failed talks.
He said CIGNA generally pays its bills promptly but that he had a problem with its bundling and downcoding payments that has put him on the edge of bankruptcy. Dr. Allen dropped out of the CIGNA program once because he couldn't afford to pay his bills with the reimbursement he received. But he signed another contract because so many of his patients -- he has been in Arlington for 31 years -- had CIGNA insurance and wanted to continue seeing him.
Dr. Allen thought he had an agreement with CIGNA that would let him meet his financial obligations. But he said that in May 2001, he got a letter from the company saying it needed to adjust its fee schedule. CIGNA did not provide the specifics of the adjusted fee schedule, which he said has not been enough to cover expenses.
Although Dr. Allen estimates he's out tens of thousands of dollars over the years, he said the lawsuit's aim is not to get money from the company.
"The aim is to get CIGNA to act responsibly so that physicians in Texas and the rest of the United States get paid," he said.
In a statement, CIGNA executives called the complaint unwarranted. "In fact, through our efforts with the Coalition for Affordable Quality Health Care, we have been working with doctors and other health advocates to improve health care quality and simplify administrative practices," the insurer said. "We take our claims processing and payment responsibilities very seriously."
CIGNA said it makes every effort "to pay properly coded and legitimate claims promptly and accurately."
ADDITIONAL INFORMATION:
Case at a glance
- David E. Rogers et al. v. CIGNA Healthcare of Texas Inc.
- Venue: District Court of Travis County, Texas
- At issue: Whether the health care company stole services from physicians and breached their contracts by downcoding and bundling payments.
- Potential impact: Texas physicians hope to change the way the insurer pays them and others for health services provided to CIGNA patients.
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