Florida Medical Practice Sues Cigna for Wrongfully Partially Paid and Denied Claims

A complaint was filed on Thursday in the Southern District of Florida by Neurosurgical Consultants of South Florida, LLC against Cigna Health and Life Insurance Company. The suit alleges that the defendant failed to reimburse the plaintiff for services they provided to patients that were covered under Cigna’s health insurance policies.

Neurosurgical Consultants of South Florida, or NCSF, “provides medical services, including conservative care and surgical management on a variety of neurological conditions of the brain and spine to patients in Palm Beach County, Florida.” According to court documents, from 2019 and 2020, the plaintiff provided medically necessary treatment to six patients, identified as L.M., Z.O., K.S., H.S., T.S., and G.S.

The patients each had a health insurance policy that was issued, insured, and administered by Cigna. When insurance claims were submitted to the defendant for each of the six patients, the claims were either partially paid, denied, deemed not medically necessary, or denied with the reasoning that the services were experimental.

The plaintiff claims that the amounts the defendant paid for the claims did not correspond with the “statutory language mandated under Florida law and usual and customary charges.” They further assert that the services were performed with the expectation and understanding that Cigna would reimburse the plaintiff.

NCSF notes that “prior to all non-emergent initial consultations with each new patient, plaintiff contacted Cigna to verify that each patient was covered by a health plan insured by and/or administered by defendant, and to obtain benefit information and pre-authorization for the services to be provided.”

NCSF explains that the defendant’s refusal to compensate them for the insurance claims has caused them to sustain damages since the claims do not include any claims in which benefits were denied and also do not challenge any coverage determinations under the Employee Retirement Income Security Act.

The complaint cites claims for benefits under ERISA, unjust enrichment, and quantum relief. The plaintiff is seeking a trial by jury, favorable judgment on each count, prejudgment interest, costs, and monetary relief in an amount representing the difference between the amounts Cigna paid to NCSF for the claims at issue.

The plaintiff is represented by Di Pietro Partners, PLLC.