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Judge rules in favor of Cigna in lawsuit filed by Chicago ASC

U.S. District Judge Harry D. Leinenweber ruled in favor of Cigna regarding a lawsuit Chicago-based Advanced Ambulatory Surgical Center Inc. filed against the payer for allegedly wrongly denying reimbursement for claims for some Cigna-insured patients, according to Cook County Record.

Here's what you should know:
1. The ASC is out-of-network with Cigna. AASC allegedly forgave many Cigna-insured patients' bill due to the ASC's OON status.

2. Many patients seek OON providers to bypass copays and deductibles they would pay for in-network providers. Cigna issued policy changes saying it will deny reimbursement to OON providers that the payer suspected of fee forgiveness.

3. In October 2010, Cigna launched an investigation into the ASC and sent the surgery center a letter asking about its payment collection methods. The surgery center did not respond, prompting Cigna to send another letter in December 2010 that said the payer would deny all questionable policy claims until AASC could provide evidence that the ASC was requiring Cigna plan members receiving treatment at the ASC to pay the full "applicable OON co-insurance and/or deductible."

4. Cook County Record reports the ASC denies fee forgiveness and claims. The surgery center it would sometimes write off patient cost shares as charity if patients could not make a full payment.

5. Mr. Leinenweber said although AASC employees very well may have verified patient insurance coverage with a Cigna representative over a phone call before offering treatment to Cigna-insured patients, verifying coverage benefits is not "a concomitant promise of payment."

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