Cigna Ordered to Pay $13 Million in Unpaid Claims

A judge has ordered Cigna to pay Houston-area Humble Surgical Hospital $13 million for almost 600 unpaid claims. Cigna and its Connecticut General Life affiliate sued the hospital in 2013 accusing it of over-billing for medical services. A federal judge not only disallowed Cigna’s claim against the hospital, it ordered Cigna to pay the hospital for medical service rendered to people insured by Cigna. The hospital was able to demonstrate that Cigna had not paid it a cent since 2014. The judge wrote, “Cigna’s method for processing Humble’s claims was simply disingenuous and arbitrary.”

As I predicted months ago, it is also appearing increasingly less likely that the merger between Cigna and Anthem will take place. The Wall Street Journal has reported that the two companies are blaming each other of violating the merger agreement and “fumbling submissions to regulators.” I suspect that both companies are correct in their accusations.

I am only acquainted with Anthem by reputation, and its reputation is not good. However, I have the misfortune to be a Cigna-Healthspring Medicare Advantage customer, so I know some of its problems first hand. As you may know, the federal government has prohibited Cigna from signing up new Medicare Advantage customers or advertising its Medicare Advantage plans until Cigna straightens out its administrative and computer problems.

Occasionally I get an emailed questionnaire from Cigna asking me to evaluate this or that online feature. The survey is hard to complete, because the Cigna websites do not work properly. I cannot evaluate information that Cigna’s computer systems do not enable me to access. I may be asked for example how I like the format that my insurance information is presented on, but my insurance information isn’t there. In fact, if I download my “proof of insurance” from the site, I get the information for 2015. The only 2016 information there is my drug plan.

I hope Cigna straightens out its mess, although so far it is not looking promising. I like my Healthspring doctors. Healthspring was taken over by Cigna, and the doctors are still good. However, the computer systems that support them do not work properly. A few weeks ago a pharmacist at a Cigna pharmacy asked me for a list of medications I had been prescribed. I answered that the list was already in the computer. “Oh, our computer system doesn’t communicate with the one the doctors use,” was the answer. That’s a typical Cigna problem. Communication within the company itself is dysfunctional, so it is no wonder that Cigna cannot communicate with the people it insures and the medical staff that provides service.

Dysfunctional communication seems to be at the heart of Cigna’s problems. The company has a plethora of computer systems that are not well programmed and that do not talk to each other. I do not believe that Cigna’s problems are the result of malevolence. They are caused by Cigna’s incompetence. Cigna’s management is inept.

Incidentally, I write this blog to publicize my books. You can learn more about several of them by clicking on the book cover images in the left sidebar.