Cigna Sued in COVID Test Billing Dispute

On Wednesday a case was filed in the Southern District of Texas by Diagnostic Affiliates of Northeast Houston, doing business as 24 Hour Covid RT-PCR Laboratory against Cigna Health Insurance and its affiliates. The case alleges that Cigna failed to properly reimburse the plaintiff for rapid COVID-19 testing.

Diagnostic Affiliates, the complaint says, is a certified high complexity lab and offered COVID-19 testing at seven different collection sites in Texas. The plaintiff is out-of-network with insurance giant Cigna and does not have a pricing contract with the insurance company.

The complaint contends that under the provisions of the CARES Act, COVID-19 is a mandatory benefit for all health insurance plans, without cost-sharing, pre-authorization, or other medical management requirements. Regarding the payment, “Section  3202(a)  of  the  CARES  Act  provides  that  all  group  health plans  and  health  insurance  issuers  covering  Covid  Testing  items  and  services,  as described  in Section 6001 of the FFCRA, must reimburse OON providers in an amount that equals the cash price for such Covid Testing services as listed by the OON provider on its public internet website or to negotiate a rate/amount to be paid that is less than the publicized cash price.”

The plaintiff argues that the defendants have received offers for a negotiated rate, but has not responded to these offers, therefore the claims should be paid at the cash price.

The plaintiff is suing for breach of fiduciary duty, declaratory judgment, failure to provide documentation, and violation of the CARES Act. The plaintiff is represented by Ebad Khan.