CIGNA vs. Humble– Impact on Balance Billing and OON Providers

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Recent Ruling of Cigna vs. Humble is a Victory for Out-of-Network Providers


Recently, in a landmark decision for Out-Of-Network (OON) providers nationwide, a U.S. District Judge Kenneth Hoyt of the Southern District of Texas ruled against Cigna and ordered the insurer to pay $11.4 million to cover underpaid claims, and an additional $2.3 million in ERISA penalties. This is the first instance where a claims administrator was ordered to pay ERISA penalties to a medical provider.

In what is most likely a shift in out-of-network reimbursement and claims processing, the Court ruled that Cigna could not deny claims based on the purported waiver by Humble of patient’s deductibles, co-pays or co-insurance.  Per the rules, Cigna had no right under ERISA to absolve itself from its responsibility to pay the claims because it assumed that it could demand upfront payment of deductibles, co-pays and co-insurance.

Out-of-network providers need to understand and utilize this important decision to compel health insurers to pay out-of-network claims. Join expert speaker Thomas J. Force, Esq.—a licensed attorney—in this informative session to get an easy break down of this complicated legal precedent and how it impacts OONs.

This 60-minute session is packed with tips and tricks regarding balance billing issues for the out of network provider.

Session Highlights:

  • Cigna vs. Humble Surgical Hospital
    • Facts
    • How Cigna decided to hold up claims due to Fee Forgiveness
    • Details on the lawsuit under ERISA
    • Court’s rulings on Cigna’s claim
    • The Big Victory for Humble!
    • Jurisdiction – Where is this case Precedent?
    • Impact on OON non-paid claims held up due to failure to balance bill/collect coinsurance and deductibles
    • Impact on OON Balance Bill Audits
    • Impact on OON claims
    • How the Court enforced ERISA Appeals and Claims Guidelines
  • How this new development redefines “fee-forgiving”
  • How the court views balance billing
  • ERISA violations for the ínsurance company based on its bad faith actions
  • How providers can protect themselves from similar situations

Who should attend

Healthcare Executives, Physicians, Front Office and Billing Staff, Revenue Cycle Personnel, Practice Managers, Compliance Professionals & Attorneys

Order Below or Call 1-866-458-2965 Today

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About Our Speaker

Thomas Force - Compliance Coding Expert

Thomas J. Force, Esq. is a licensed attorney since 1994 in both the state and federal courts for the states of New Jersey and New York with 27 years in the healthcare and insurance industries. He is the President and Founder of The Patriot Group, a full service health care physician advocacy and revenue recovery company providing billing, appeals, collections and follow up services for health care.A Former...   More Info
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