In a recent landmark decision for out-of-network (OON) providers nationwide, a federal judge in 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 in which a claims administrator was ordered to pay ERISA penalties to a medical provider.
In what will most likely result in a major shift in the treatment of OON reimbursement and claims processing, the court ruled that Cigna could not deny claims based on the purported waiver by Humble of patients’ deductibles, co-pays or co-insurance. According to the court, Cigna had no right under ERISA to absolve itself of its responsibility to pay the claims because it assumed that it could demand upfront payment of deductibles, co-pays and co-insurance.
OON providers need to understand the significant impact of this court decision on their ability to compel health insurers to pay OON claims correctly. Join expert speaker and licensed attorney Thomas J. Force, Esq. in this informative session to get an easy breakdown of this complicated decision and how it impacts OON providers.
This 60-minute session is packed with tips and tricks regarding balance billing issues in the wake of this important victory for a physician-owned hospital.
Who should attend
Thomas J. Force, Esq. is a licensed attorney since 1994 in both state and federal courts in New Jersey and New York, with 27 years of experience in the healthcare and insurance industries. He is the president and founder of The Patriot Group, a full-service healthcare physician advocacy and revenue recovery company providing billing, appeals, collections and follow-up services for healthcare. Thomas is also the former CEO, general...
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