Cigna Wins Billing Dispute Over Substance Abuse Treatment Center

Cigna Health & Life Insurance Co. defeated a federal lawsuit claiming it wrongly failed to cover more than 100 patients’ medical care at a now-bankrupt substance abuse treatment center.

Cigna had discretionary authority over the contested benefit claims and its decision to deny coverage “is not only reasonable but likely the best reading” of the relevant coverage exclusion, the US District Court for the Central District of California held Dec. 9. Cigna reasonably concluded after a detailed investigation that the treatments fell under a plan exclusion for “fee-forgiving,” which occurs when a provider seeks insurance reimbursement for a charge that ...