The American Medical Association, the Medical Society of New Jersey and the Washington State Medical Association joined a class-action lawsuit against Cigna Sept. 12 for allegedly failing to pay medical claims in full after members submitted them through MultiPlan, the nation's largest PPO network.
The lawsuit was originally filed by Cigna members June 10 in a Connecticut federal court and accuses the payer of a purposeful scheme to underpay claims and increase administrative fees.
According to the original lawsuit, Cigna is a MultiPlan client and must accept a set percentage of a provider charge as a full payment, which means patients are not responsible for discrepancies between the original charge and the lower MultiPlan price.
When processing member claims submitted through the MultiPlan network, Cigna is supposed to apply the MultiPlan rate and not use its out-of-network rates — the lawsuit claims the payer occasionally does the opposite, thereby underpaying claims and failing to provide full benefits to members.
"By engaging in this misconduct, Cigna … breached its fiduciary duties, including its duty to honor written plan terms and its duty of loyalty, because its conduct serves Cigna's own economic self-interest and elevates Cigna's interests above the interests of plan member patients," the suit said.
Becker's has reached out to Cigna for comment and will update this story if more information becomes available.