News: Cigna sued for denied COVID-19 testing and treatment claims

Open MRI and Imaging of RP Vestibular Diagnostics PA has filed a lawsuit against Cigna Health and Life Insurance Co. The New Jersey-based radiology lab claims that the insurer wrongfully denied reimbursement for nearly $400,000 in services that the facility provided to COVID-19 patients over the past five months, and that this coverage denial violates the insurance coverage provisions of the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

According to the lawsuit, “the grounds for rejecting plaintiff’s claims were, upon information and belief, false and invalid.” Open MRI and Imaging of RP Vestibular Diagnostics PA states that Cigna’s decisions to deny coverage were “arbitrary.”

Under the CARES act, insurers are required to cover certain tests and treatments of COVID-19 with no cost-sharing or prior authorization. The lawsuit does not make clear if the radiology lab office is in Cigna’s network.

Editor’s note: Click here to read the lawsuit filed against Cigna. The November/December edition of ACDIS’ CDI Journal will focus on denials management and appeals. ACDIS is currently looking for contributed articles to this edition that fit the theme. Submissions are due by October 1, 2020. If you are interested in writing for the edition, contact ACDIS Editor Linnea Archibald (larchibald@acdis.org) and Associate Editor Carolyn Riel (criel@acdis.org).