According to the judge, Cigna’s claim denials were based on the insurer’s flawed interpretation of exclusionary language in self-funded plans it administered.
“Cigna’s interpretation of ‘exclusionary’ language as rejecting covered services, was improper and violative of the plans’ terms,” the judge concluded.
The judge ordered Cigna to pay $11.4 million in damages and $2.3 million in penalties under the Employee Retirement Income Security Act. The insurer will also pay the hospital’s attorney fees, which will be determined at a later date.
Humble filed suit against Cigna after the insurer sued the hospital alleging it had inflated its bills. The court dismissed all of Cigna’s claims.
Read the full story on Becker Hospital Review’s here.