The hospitals filed a lawsuit against Cigna in 2020 alleging that Cigna paid less than the community rate for care provided to the insurer’s members, according to court records. The hospitals said they provided out-of-network emergency treatment to “numerous Cigna customers.” Cigna reimbursed the hospitals 15 percent of what they charged.
Cigna argued that the hospitals were basing the claims of community rate based only on their own prices and not on amounts charged in the broader Miami-Dade and Palm Beach communities, according to court records. A federal district judge agreed and granted summary judgment.
A panel of Eleventh District Appeals Court judges overturned the decision, stating that “even if the relevant ‘community’ extends beyond the eight plaintiff hospitals, their receipts alone are enough to create a genuine factual dispute about what the ‘community’ rates are.
“Whatever the term’s precise platonic meaning, the ‘community’ issue in this case belongs in front of a jury,” the judges stated in their ruling.
The hospitals involved in the case are Pinewood-based North Shore Medical Center, Hialeah-based Palmetto General Hospital, Delray Beach-based Delray Medical Center, West Palm Beach-based Good Samaritan Medical Center and St. Mary’s Medical Center, Palm Beach Gardens Medical Center, Coral Gables Hospital and Boca Raton-based West Boca Medical Center.
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