The American Medical Association is accusing health insurer Cigna of underpaying claims filed by providers in the contracted MultiPlan network, the largest third-party network in the country. The AMA has joined a class-action lawsuit alleging the insurer reimbursed for claims at non-participating providers’ rates rather than the expected MultiPlan contract rates, Healthcare Finance reports.
Cigna contracts with MultiPlan to access providers. The AMA and other plaintiffs contend the insurer significantly underpaid claims and put patients at risk of balance billing, and breached certain fiduciary duties, “including its duty to honor written plan terms and its duty of loyalty, because its conduct serves Cigna’s own economic self-interest and elevates Cigna’s interests above the interests of plan member patients.”
The plaintiffs contend that the alleged misconduct advances Cigna’s self-interest because it allows the company to collect higher administrative fees. Read more.
