A New Jersey medical office has filed suit against Cigna, alleging that the insurer failed to pay for diagnostic testing and treatment related to COVID-19 in violation of the CARES Act.
Open MRI and Imaging of RP Vestibular Diagnostics claims that Cigna owes it nearly $400,000 in unpaid claims for care related to the novel coronavirus, and that the decisions to decline coverage were "arbitrary."
The group says the denied claims are from February to July.
"The explanations given by [Cigna] for its refusal to make payment include unelaborated denials that the services were rendered as billed, or matched the services billed, as well as the occasional contention that the billing was duplicative," according to the lawsuit. "The grounds for rejecting plaintiff's claims were, upon information and belief, false and invalid."
We've reached out to Cigna and will update this story when we hear back.
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Under the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, insurers are required to cover a number of diagnostics and treatments for COVID-19 with no cost-sharing, prior authorization or other medical management tactics.
The lawsuit does not make clear if the New Jersey office is in Cigna's network, but the CARES Act includes provisions that aim to avoid surprise billing for COVID-19 care.
The suit also comes as legislators are taking a closer look at insurers' financial performance amid the pandemic. Plummeting patient volumes significantly boosted payers' bottom lines in the first half of the year.
Rep. Frank Pallone, D-N.J., chair of the House Energy and Commerce Committee, which launched the probe, said the sky-high profits suggest insurers may not be doing their part to address the pandemic.