Medical Practice Sues Cigna Over COVID-19 Testing Costs

A complaint was filed today against Cigna Health and Life Insurance by Murphy Medical Associates regarding the provision of COVID-19 testing in the state of Connecticut. This complaint, filed in the United States District Court for the District of Connecticut, alleges a violation of Families First Coronavirus Response Act (FFCRA), the Employee Retirement Income Security Act (ERISA), and the Connecticut Unfair Insurance Practices Act.

According to the complaint, FFCRA mandated that health plans and managed care companies cover and reimburse laboratories for costs associated with medically necessary testing for the COVID-19 virus, without cost share, so long as the testing was provided in accordance with acceptable standards of current medical practice. The plaintiff, Murphy, set up drive through testing locations in the state of Connecticut for testing, including the use of tests and procedures specifically authorized under the Food and Drug Administration’s protocols. The plaintiff also provided blood testing and follow up counseling regarding wellness and treatment plans.

After being billed by Murphy, Cigna requested medical necessity and utilization review documentation for each of the tests that were performed by Murphy. Per Murphy, these documentation requests have caused unnecessary delay in payment, reductions in payment, and overall have been intended to reduce the payment amounts through sheer volume of the requests. The plaintiff alleges a direct violation of the FFCRA in that 3202(a) of the CARES Act mandates a payment at the cash list price of the testing facility if the insurance company does not have a contractual discount with the provider. The plaintiff also alleges that the requested documentation is a violation of the rules regarding ERISA appeals and that Cigna has defamed the medical practice by advising patients not to seek testing at the facilities due to the billing disputes.

The plaintiffs are represented by Garfunkel Wild.