19 Tenet hospitals sue Cigna over alleged low reimbursement rates, denied claims

Tenet Healthcare and 19 of its hospitals are accusing Cigna of reimbursing claims at low rates and wrongfully denying claims for emergency care in a lawsuit.

The suit was first filed March 23 in state court but was moved April 28 to Connecticut District Court, according to the Connecticut Law Tribune.

Nineteen hospitals managed by Tenet across Arizona, Florida, Tennessee, Alabama, South Carolina and Massachusetts allege Cigna engaged in "an ongoing pattern of financial misconduct."

The hospitals allege Cigna created "narrow" networks — which Tenet is not part of — to maximize the discounts it receives from the limited number of hospitals participating in those networks, thereby creating the risk of members seeking care at out-of-network emergency departments that have not agreed to offer discounted rates. The lawsuit claims Cigna forced Tenet hospitals to treat members at artificially low rates by reimbursing the hospitals at rates they did not agree to.

The lawsuit also claims Cigna "arbitrarily denied numerous claims for emergency medical services."

The hospitals said they have attempted to join Cigna's provider network, but the company refused. 

"By keeping the Tenet hospitals out-of-network, Cigna appropriated for itself the ability to unilaterally determine the reimbursement amounts it will pay for emergency care rendered to its members. And by systematically underpaying and denying claims for that care, Cigna is able to drive its enormous profits," the lawsuit said.

Through the alleged discounted rates and denied claims, the lawsuit says Cigna violated common law, state laws and the Connecticut Unfair Trade Practices Act.

The plaintiffs said "Cigna's scheme" is currently ongoing and nationwide. They are seeking compensation for resulting injuries, including actual, punitive and monetary damages, attorneys' fees, award interest and costs.

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