AMA joins plaintiffs in class-action lawsuit against Cigna

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The American Medical Association has joined plaintiffs in a class-action lawsuit against Cigna, alleging that the payer engaged in misconduct by underpaying provider claims in its MultiPlan network.

Other medical groups, including the Medical Society of New Jersey and Washington State Medical Association, have also joined the plaintiffs.

The lawsuit, which was filed in a Connecticut District Court, claims that Cigna reimbursed MultiPlan providers at its non-participating provider rate, rather than the participating provider rate, leaving clients “exposed to the threat of balance billing” and ultimately underpaying claims.

Balance billing is when providers bill patients for the cash difference between original charges billed and discounted rates, something that MultiPlan providers are prohibited from doing in their contracts with the network, according to the suit.

The No Surprises Act, which went into effect in January, outlaws balanced billing and is meant to protect patients from receiving out-of-network bills from care they received at in-network facilities. However, one in five Americans reported receiving surprise bills this year, despite the NSA going into effect.

Cigna is a client of MultiPlan, the country’s largest “third-party network” company, which allows Cigna to contract with MultiPlan providers. MultiPlan has contracts with over 1.2 million providers, according to the suit.

Cigna “breached its 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,” according to the lawsuit, filed on June 10.

Jack Resneck, president of the AMA, said that the insurer has allowed its “economic self-interest to be prioritized ahead of their promises to physicians in the Multiplan Network and their patients.”

“Patients and physicians have a right to expect health insurers to uphold their promise to provide fair and accurate payment for medical services,” Resneck said in a statement. “By joining Stewart v. Cigna as a plaintiff, the AMA hopes to shed light on Cigna’s misconduct and create remedies so that patients and physicians can look forward to getting what they are promised.”

Cigna did not respond to a request for comment.

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First Medicaid mobile mental health service to launch in Oregon

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Dive Brief:

  • Oregon will launch the country’s first Medicaid-supported mobile crisis intervention program providing stabilization services to people with mental health or substance use conditions, including opioid use, the HHS announced. The program offers immediate assessment, stabilization and de-escalation help for people in crisis, and coordinates referrals for other social services like life skills training.
  • Immediate, appropriate behavioral health care can help reduce the risk of harm and the need for costly inpatient services, the HHS said. The initiative also allows law enforcement to focus more on accountable policing and less on work that should be handled by mental health counselors or social workers, the agency said.
  • Oregon was the first state to apply and gain approval for the new Medicaid option, created through the Biden administration’s American Rescue Plan. HHS Secretary Xavier Becerra, in a statement announcing the approval, encouraged additional states to take advantage of the opportunity for funding to expand access to crisis care.

Dive Insight:

The mobile intervention program is part of President Joe Biden’s strategy for addressing the country’s mental health crisis, a steadily worsening problem that has become more acute during the COVID-19 pandemic. Biden laid out plans to strengthen the national crisis response infrastructure earlier this year as part of his State of the Union agenda.

That strategy includes the transition in July to the 988 crisis hotline, which replaced the 10-digit National Suicide Prevention Lifeline. Community-based mobile crisis intervention services such as Oregon’s are expected to support the 988 network of state and local call centers, the HHS said.

The American Rescue Plan, which became law last year, included $15 million in planning grants to help 20 state Medicaid agencies develop crisis care programs.

Oregon is the first of the 20 states that received planning grants to qualify for a higher federal Medicaid match of 85% for the next three years to reimburse mobile crisis services delivered to Medicaid beneficiaries.

People throughout the state experiencing a mental health or substance use crisis can connect to a behavioral health specialist 24 hours a day, every day of the year, the HHS said.

“Prioritizing behavioral health treatment by putting crisis care in reach for more Americans is critical — in Oregon and beyond,” Becerra said.

The Biden administration has spent $432 million in fiscal 2022 to support the 988 transition, scale up crisis center and national back-up center capacity, improve response rates, and ensure that calls are first routed to local, regional or state crisis call centers, the HHS said.

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