An individual filed suit on Tuesday in the Southern District of New York against defendant Cigna Health and Life Insurance Company. The complaint alleges that the defendant violated coronavirus aid acts when it improperly denied the plaintiff’s claim for COVID-19 testing coverage.
According to the complaint, the plaintiff was a beneficiary of Cigna’s insurance policy, which is governed by the Employee Retirement Income Security Act of 1974 (ERISA). As noted in the complaint, in March 2020, the United States government passed the Families First Coronavirus Response Act, which was followed by another coronavirus aid act that obligated insurers like Cigna to “reimburse in full the cost paid by a beneficiary for diagnostic Covid-19 testing, without imposing any cost-sharing, co-payments, deductibles, or coinsurance, regardless of whether the provider is in-network or out-of-network.”
In January 2022, the plaintiff obtained a COVID-19 test for which he paid $250 out of pocket. The provider from which he obtained the test was considered an out-of-network provider under the terms of Cigna’s policy. When the plaintiff submitted a claim for the $250 to Cigna, it paid $51.31 of the claim, leaving $198.69 remaining. Cigna asserted that it denied the remainder of the claim because there was a discount of $198.69 applied to the test that it negotiated.
However, the plaintiff contends that there was no discount applied to the test as Cigna reported. Rather, the plaintiff was forced to pay the amount that constituted Cigna’s “discount,” which totaled $198.69.
According to the complaint, the plaintiff communicated with Cigna in an attempt to contest the claim determination, maintaining that the test should have been fully covered under coronavirus aid acts like the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). Cigna responded by explaining that it paid the provider’s normal charge. The plaintiff claims that this contradicts Cigna’s earlier reasoning for denying the claim, specifically that it negotiated a discount with the provider.
The plaintiff explains that this is not the first time Cigna has improperly denied coverage for a COVID-19 test claim. The complaint states that each time “Cigna ignored, and did not respond, to Plaintiff’s assertion that the subject Covid-19 tests should be covered in full under the CARES Act.” As a result, the plaintiff claims that Cigna violated ERISA.
The three counts cited in the complaint are: claims processing in breach of fiduciary duty, failure to afford full and fair review, and failure to provide adequate notice. The plaintiff is seeking class certification for himself and all others similarly situated, equitable and injunctive relief, a declaration that the defendant’s actions are unlawful, litigation fees, interest as allowed by law, and more.
The plaintiff is represented by Posner Law PLLC.
