Cigna and American Specialty Health, Cigna's claims processor, have finally settled two huge class-action lawsuits by agreeing (without admitting wrongdoing) to pay a total of $20 million. Details of the larger settlement* were provided to us by Jeff Randolph, Esq., general counsel for the Association of New Jersey Chiropractors. (Former ANJC President, Dr. Steven Clarke, was one of the lead plaintiffs in the suit.) According to Randolph in an article featured in our next issue:
"The class-action lawsuit arose, in part, from a Market Conduct Study of ASH conducted by the New Jersey Department of Banking and Insurance in 2012. As a result of the study, NJDOBI inspectors found that 'the Company's practices did not accord fully with various provisions of New Jersey insurance statutes or regulations ... where the frequency of error was such as to constitute an improper general business practice' (NJDOBI Market Conduct Study Consent Order E12-101). The NJDOBI inspectors found error ratios of 56 percent on electronic claims and 55 percent of paper claim for a total error ratio of 56 percent for random files."
"The NJDOBI noted that American Specialty Health misrepresented pertinent facts or insurance policy provisions on its EOBs by including its administrative compensation in the amount billed section of the form. The NJDOBI examiners concluded: 'Accordingly, the EOB is untrue and misrepresents pertinent facts, contrary to N.J.S.A. §17B:30-13.1a.'"
According to Randolph, the settlement also requires ASH to "make reasonable efforts to enact certain business reforms related to the conduct challenged by Plaintiffs."
*Cigna and ASH also settled for $8.25 million to resolve a class action alleging they charged inappropriate administrative fees. Several other suits are in the works.
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