The lawsuit was filed in May 2022 in the U.S. District Court for the Southern District of New York. The plaintiff sought reimbursement after paying $250 for an out-of-network COVID-19 test, but Cigna covered only $51, claiming the lower amount was a negotiated discount.
The lawsuit argued that Cigna’s actions violated ERISA and the CARES Act, which required insurers to reimburse the full cost of COVID-19 tests without imposing out-of-pocket costs on patients, regardless of the provider’s network status. The plaintiff claimed that Cigna failed to adhere to these requirements and provided inconsistent and misleading explanations for its reimbursement policies. In some cases, Cigna allegedly said it had negotiated discounts that did not actually exist, while in others, it cited a reimbursement methodology similar to Medicare, creating confusion and inconsistency.
The parties reached a settlement agreement on Jan. 29. Under the settlement terms, Cigna will establish a fund of $2.9 million, which will be used to compensate affected individuals by covering 85% of the difference between what they paid for testing and what Cigna reimbursed. Approximately 28,000 claims are expected to be covered by the settlement, with an average payout of $104 per claim. A hearing is scheduled for May 29 to finalize the settlement.
