Air Medical Providers File Lawsuit Against Cigna Health and Life Insurance Company
4.17.2023
Cigna violated federal law by failing to pay awards issued under Federal No Surprises Act.
REACH Air Medical Services (REACH), Guardian Flight (Guardian), Med-Trans Corporation (Med-Trans) and Air Evac Lifeteam (Air Evac) announced today that they have filed a lawsuit against one of the nation’s largest health insurance companies, Cigna Health and Life Insurance, for violating federal law by failing to pay out-of-network payment awards issued to the air ambulance providers under the federal No Surprises Act (NSA).
The four air medical companies are owed a total of $2 million in payments for claims since July 2022. The suit was filed in the U.S. District Court, Southern District of Texas, Houston Division.
“After losing in the Independent Dispute Resolution (IDR) proceedings for dozens of air ambulance claims, Cigna was given thirty days under federal law to pay the additional amounts owed to these providers, yet they continue their flagrant illegal practices and make it impossible for them to receive payment,” Joe Don Ridgell, associate general counsel for Global Medical Response.
The NSA established the IDR process to resolve payment disputes for out-of-network services provided to patients in specific emergency and non-emergency situations. The process requires that both parties submit proposed offers of payment, which are then evaluated based on many factors. Once an appropriate payment amount is established for the transport, the health plan is required by law to remit payment within thirty days. Since the implementation of the NSA, air ambulance providers that are part of the Global Medical Response family of companies have won more than 90 percent of IDR disputes, proving that insurance companies have been drastically underpaying air medical providers for transport costs.
“Many payors have stated that air medical providers are now taking every claim to IDR, but that is categorically false,” said Ridgell. “Only seven percent of GMR’s overall transports are even eligible to go through the IDR process, and when we are winning more than 90 percent of disputes it seems that it is the insurers that underpaying every claim that requires providers to pursue proper reimbursement.”
The lack of payments from Cigna jeopardizes air medical providers’ ability to continue providing access to lifesaving care for patients in historically underserved and rural communities because of the high costs associated with operating an air medical base.
The four air medical companies are owed a total of $2 million in payments for claims since July 2022. The suit was filed in the U.S. District Court, Southern District of Texas, Houston Division.
“After losing in the Independent Dispute Resolution (IDR) proceedings for dozens of air ambulance claims, Cigna was given thirty days under federal law to pay the additional amounts owed to these providers, yet they continue their flagrant illegal practices and make it impossible for them to receive payment,” Joe Don Ridgell, associate general counsel for Global Medical Response.
The NSA established the IDR process to resolve payment disputes for out-of-network services provided to patients in specific emergency and non-emergency situations. The process requires that both parties submit proposed offers of payment, which are then evaluated based on many factors. Once an appropriate payment amount is established for the transport, the health plan is required by law to remit payment within thirty days. Since the implementation of the NSA, air ambulance providers that are part of the Global Medical Response family of companies have won more than 90 percent of IDR disputes, proving that insurance companies have been drastically underpaying air medical providers for transport costs.
“Many payors have stated that air medical providers are now taking every claim to IDR, but that is categorically false,” said Ridgell. “Only seven percent of GMR’s overall transports are even eligible to go through the IDR process, and when we are winning more than 90 percent of disputes it seems that it is the insurers that underpaying every claim that requires providers to pursue proper reimbursement.”
The lack of payments from Cigna jeopardizes air medical providers’ ability to continue providing access to lifesaving care for patients in historically underserved and rural communities because of the high costs associated with operating an air medical base.
