On Monday, California Spine and Neurosurgery Institute filed a complaint in the Northern District of California against Cigna Health and Life Insurance Company for failing to pay insurance claims in accordance with the Employee Retirement Income Security Act (ERISA).
According to the complaint, California Spine and Neurosurgery Institute is a California corporation doing business as San Jose Neurospine (SJN). The complaint states that SJN specializes in sophisticated surgical procedures involving minimally invasive spinal procedures
to complex spinal reconstruction. Further, the complaint states that CIgna Health and Life Insurance Company is a Connecticut based insurance company and among other things an insurer and administrator of health benefit plans covered by ERISA.
The complaint states that from April 1, 2015 to November 22, 2021, SJN provided eight surgical services for seven different patients insured under Cigna health benefit plans. SJN alleges that, before each of these procedures, office staff contacted Cigna to verify patient coverage before performing the surgery. The complaint alleges that Cigna confirmed coverage for each of the patients under a ERISA plan for an out-of-network provider. Once SJN received verification that the specified procedure was covered by a Cigna ERISA plan, it provided the surgery services to the patient.
However, SJN alleges that Cigna has refused to pay the claims for the eight surgical procedures and has failed to adequately provide an explanation. Therefore, SJN brought the present lawsuit seeking to recover payment for the ERISA plan benefit claims against Cigna and attorney’s fees. SJN is represented by Williams Wollitz Hakakian PC.