Cigna Settles ERISA Lawsuit
Los Angeles, CA: Cigna has agreed to settle an ERISA lawsuit alleging patient harassment. The ERISA lawsuit was filed against Cigna by Nutrishare Inc, an intravenous nutrition provider. In the lawsuit, Nutrishare alleged Cigna harassed patients who attempted to use out-of-network benefits and denied coverage that should have been allowed.
According to court documents, Nutrishare alleges that Cigna advertised health insurance policies as giving patients the choice to obtain health care from any health care provider, even if that health care provider is considered “out of network,” although plans that allow for out-of-network health care cost more than those that have restrictive health care provider options. Nutrishare offers long-term, in-home intravenous nutrition services allowing patients to obtain nutrition they need to survive serious illness and infection, but is considered by Cigna to be an out-of-network provider.
Nutrishare claims Cigna retaliates against patients who attempt to use their out-of-network benefits by “making threatening telephone calls to those patients, by directing the patients’ physicians to encourage the patients to switch from out-of-network providers to inferior, in-network providers, and by underpaying and/or failing to pay the patients’ out-of-network providers.” Furthermore, Cigna is accused of denying payment or underpaying for services provided using false pretenses, forcing patients to incur financial liability.
In the lawsuit, Nutrishare gives the example of one patient who was diagnosed with idiopathic gastroparesis, which causes partial paralysis of the stomach. The patient requires daily TPN (total parenteral nutrition) for more than 10 hours a day to ensure she receives enough nutrients and calories to survive. The patient (whose name is not given in court documents) was allegedly directed by Cigna to use an in-network provider for her TPN services, but suffered from central line infections, and was given incorrect or incomplete orders of TPN products and supplies. On the advice of her physician, the patient switched to Nutrishare and has since not suffered any complications. According to the lawsuit, Cigna responded by phoning both the patient and the patient’s physician, making the patient feel threatened.
Additionally, Cigna is accused of not properly paying for services that should be covered for patients who pay extra to use out-of-network services.
“The goal of Cigna’s harassment and failures to pay are clear: Cigna wants to save money by coercing its patients into using only in-network providers, despite the fact that these members pay for PPO plans that permit full access to out-of-network providers and that these patients do not want to switch to a different, inferior provider of TPN services,” the lawsuit alleges. “One of Cigna’s tactics for achieving this goal is to make providing services to Cigna members so unattractive to Nutrishare - because those services will not be paid for - that Nutrishare will have no choice but to turn away Cigna patients in the future.”
Cigna has reportedly agreed to settle the lawsuit, which alleged the company violated the Employee Income Retirement Security Act by intimidating policyholders into using in-network health care providers.
The lawsuit is Nutrishare, Inc., et al v. Connecticut General Life Insurance Company, et al, Case number 2:15-cv-00351.
According to court documents, Nutrishare alleges that Cigna advertised health insurance policies as giving patients the choice to obtain health care from any health care provider, even if that health care provider is considered “out of network,” although plans that allow for out-of-network health care cost more than those that have restrictive health care provider options. Nutrishare offers long-term, in-home intravenous nutrition services allowing patients to obtain nutrition they need to survive serious illness and infection, but is considered by Cigna to be an out-of-network provider.
Nutrishare claims Cigna retaliates against patients who attempt to use their out-of-network benefits by “making threatening telephone calls to those patients, by directing the patients’ physicians to encourage the patients to switch from out-of-network providers to inferior, in-network providers, and by underpaying and/or failing to pay the patients’ out-of-network providers.” Furthermore, Cigna is accused of denying payment or underpaying for services provided using false pretenses, forcing patients to incur financial liability.
In the lawsuit, Nutrishare gives the example of one patient who was diagnosed with idiopathic gastroparesis, which causes partial paralysis of the stomach. The patient requires daily TPN (total parenteral nutrition) for more than 10 hours a day to ensure she receives enough nutrients and calories to survive. The patient (whose name is not given in court documents) was allegedly directed by Cigna to use an in-network provider for her TPN services, but suffered from central line infections, and was given incorrect or incomplete orders of TPN products and supplies. On the advice of her physician, the patient switched to Nutrishare and has since not suffered any complications. According to the lawsuit, Cigna responded by phoning both the patient and the patient’s physician, making the patient feel threatened.
Additionally, Cigna is accused of not properly paying for services that should be covered for patients who pay extra to use out-of-network services.
“The goal of Cigna’s harassment and failures to pay are clear: Cigna wants to save money by coercing its patients into using only in-network providers, despite the fact that these members pay for PPO plans that permit full access to out-of-network providers and that these patients do not want to switch to a different, inferior provider of TPN services,” the lawsuit alleges. “One of Cigna’s tactics for achieving this goal is to make providing services to Cigna members so unattractive to Nutrishare - because those services will not be paid for - that Nutrishare will have no choice but to turn away Cigna patients in the future.”
Cigna has reportedly agreed to settle the lawsuit, which alleged the company violated the Employee Income Retirement Security Act by intimidating policyholders into using in-network health care providers.
The lawsuit is Nutrishare, Inc., et al v. Connecticut General Life Insurance Company, et al, Case number 2:15-cv-00351.
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