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Judge Tosses Coverage Complaint Against Cigna

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An Arizona federal judge filed an order granting Cigna Health Care Inc.’s second motion to dismiss Physicians Surgery Center of Chandler’s first amended complaint against the insurance company

The order summarizes the background of the complaint, filed in October 2020, as follows: the plaintiff provides medical care to patients covered by the defendant’s insurance plan, despite the plaintiff being an out-of-network provider. In October 2018, the plaintiff received a letter from the defendant accusing them of failing to bill the defendant’s patients for their full out-of-network cost share, a practice known as “fee forgiveness.” However, the plaintiff does not practice fee forgiveness, according to the order.

The plaintiff alleges that the defendant has withheld $5.6 million in payments due.

The judge granted the defendant’s motion for the following reasons: the plaintiff has failed to state a claim for federal claims; state law claims were dismissed as well . Finally, the judge ordered the plaintiff to file their second amended complaint no later than July 15.

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