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Law360 (August 12, 2020, 5:59 PM EDT) -- Cigna Health and Life Insurance Co. was hit with a lawsuit Wednesday by a New Jersey radiology lab claiming the insurer wrongfully denied it reimbursement for nearly $400,000 in services the facility provided to COVID-19 patients over the past five months.
Open MRI and Imaging of RP Vestibular Diagnostics PA claims in its federal lawsuit that Cigna's coverage denial violated the insurance coverage provisions of the Families First Coronavirus Response Act and the Coronavirus Aid Relief and Economic Security Act.
The insurer's explanations included "unelaborated denials" that the services were billed or that they matched what was billed, or that the billing was duplicative. As a result of the denial, Cigna was unjustly enriched, the complaint alleged.
"The grounds for rejecting plaintiff's claims were, upon information and belief, false and invalid," the complaint said.
Open MRI provides diagnosis and treatment of COVID-19, among other specialties, according to the complaint. Between February and July, it submitted to Cigna invoices totaling $398,665 for diagnostic and treatment services related to the pandemic, the complaint said. Redacted copies of the invoices are included with the lawsuit.
Open MRI "faithfully" provided the services rendered, but Cigna declined payment, the complaint said. The refusal is arbitrary and runs afoul of Section 6001 of the FFCRA and Section 3202 of the CARES Act, the office said.
Section 6001 of FFCRA, which was enacted March 18, includes general requirements for group health plans and health insurers to provide coronavirus-related diagnostic and testing services during the global health crisis, according to the Centers for Medicare & Medicaid Services. The provision bars insurers from imposing cost-sharing terms such as copays, deductibles and coinsurance.
The CARES Act was enacted March 27 and includes a provision, Section 3202, that amends 6001 to include a broader range of services without any cost-sharing or prior authorization requirements.
Open MRI is seeking reimbursement as well as attorney fees and costs.
Representatives for the parties didn't immediately respond to requests for comment.
Open MRI is represented by Peter Nichols of Levine DeSantis LLC.
Counsel information for Cigna wasn't available.
The case is Open MRI & Imaging of RP Vestibular Diagnostics PA v. Cigna Health & Life Insurance Co., case number 2:20-cv-10345, in U.S. District Court for the District of New Jersey.
--Editing by Adam LoBelia.
For a reprint of this article, please contact reprints@law360.com.
