Cigna has sued Roseland Ambulatory Surgery Center in Essex County, N.J., alleging that the ASC waived the co-pays and deductibles that patients must pay when they receive treatment from an out-of-network facility, according to a North Jersey report.
The insurer wants Roseland ASC to repay more than $6.6 million, the entire amount the center received for 1,400 claims for which the patients were allegedly not billed their share. Waiving the patient's share of treatment costs is a common practice at out-of-network surgery centers in New Jersey, because it gives patients an incentive to choose out-of-network facilities despite pressure from payors.
"There are a number of facilities and doctors in New Jersey that pursue an out-of-network business model," said Phil Mann, a Cigna spokesman. That strategy is responsible for "driving up claim costs, with significantly higher charges than those billed by in-network doctors and facilities," he said. "The waiver of cost-sharing as a routine business practice is deceptive and fraudulent. Providers who engage in this are driving higher costs for all New Jersey consumers."
According to William J. Maer, a spokesman for ASC owner and anesthesiologist Richard Lipsky, the case was filed in the midst of a settlement negotiation and was done for "strategic purposes." Mr. Maer said the surgery center demanded Cigna pay "overdue and unpaid claims" prior to the lawsuit.
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