Doctors ask court to compel Cigna to pay

A claims services company representing 50,000 physicians alleges that the insurer improperly delayed payments and interfered with the process laid out by the settlement.

By Mike Norbut, AMNews staff. Sept. 5, 2005.

When Martin Saltzman, MD, learned the terms of the class-action settlement a couple of years ago between Cigna Healthcare and more than 700,000 physicians, he started to think about the money he could have coming to him because of past claims being unjustly denied, bundled or downcoded.

Dr. Saltzman, an orthopedic surgeon from Schaumburg, Ill., said he had filed enough claims for past charges to expect about $20,000 from Cigna. To date, he has received $31.10.

"What's even more insulting to me is that they're getting away with it," Dr. Saltzman said.

Even after the settlement, physicians are fighting to receive the money they feel they have coming to them from Cigna, and some have taken their complaints back to court.

Managed Care Advisory Group LLC, a claims services company representing more than 50,000 physicians, including Dr. Saltzman, is backing a motion filed by one of its clients alleging that Cigna has violated the settlement agreement by improperly delaying payment and influencing the third-party administrator to deny claims.

The motion, filed by Texas Children's Pediatric Associates in U.S. District Court, Southern District of Florida in Miami, asks that Cigna be ordered to pay MCAG's claims in full and be completely removed from the claims process in the future, with an independent third party assuming its settlement responsibilities. A hearing on the matter has not yet been set.

Physicians and claims companies representing them have submitted more than $120 million in claims for past services they feel were not fully paid. Of that total amount, MCAG submitted about $104 million in claims, said Tim Schmidt, CEO of the Sylvania, Ohio-based company.