PCA President’s statement on major court action by PA DCs against Cigna/ ASHN

Pennsylvania Chiropractic Association (PCA) President Alison M. Benedetto, DC  (Bethlehem) commented about the settlement with Cigna/ ASHN on behalf of the PCA, the state’s largest professional association representing Doctors of Chiropractic.  Dr. Benedetto’s comments were in direct response to the recent announcement of a settlement in a long-standing case between DCs and the American Specialty Health Network (ASHN).

Dr. Benedetto stated, "This new case ruling and nearly $12M settlement in Pennsylvania against Cigna and ASHN involving benefit claims processing and ERISA for out-of-network providers, is yet another example of how the court system is finally stepping in to protect patients from arbitrary denials and disruption of care. Nationwide, we are seeing more instances of court intervention addressing carriers denying patients’ access to care as seen last year in the Aetna and United rulings in California.”

She continued, “Doctors are being pushed and stressed to complete lengthier pre-authorizations and treatment plans, only to have them denied by insurers. This creates a precarious situation between the doctor and patient and questions arise as to whether the necessary documentation was properly submitted in a timely manner… all to find out that submitted treatment plans were never being read by case managers in the first place.

Given the length of time this situation was litigated over, seven or so years, today is a great day for all PCA Chiropractors, knowing that their patients’ access to affordable and safe conservative chiropractic care has been upheld and preserved by the Courts."

 

Pennsylvania Chiropractors, Cigna & ASHN End Benefits Suit With $12M Deal

By Danielle Nichole Smith

Law360 (March 27, 2019, 3:50 PM EDT) -- Cigna and American Specialty Health Inc. have agreed to an $11.8 million settlement that will resolve a nearly seven-year dispute with a proposed class of chiropractic care centers over certain denied benefit claims, as long as a Pennsylvania federal judge signs off on the deal.

 The chiropractic centers urged U.S. District Judge Nitza I. Quiñones Alejandro on Tuesday to approve the agreement, which calls for American Specialty Health to make certain business reforms in addition to the monetary relief from both it and Cigna. The centers also asked the court to certify a class of about 30,000 out-of-network chiropractic service providers, saying they met the statutory requirements for certification.

 According to the motion, the nearly $11.8 million settlement amount equals roughly a third of what the centers would have received had Cigna approved and paid in full the benefit claims at the center of the dispute. Since the centers never asserted that all the claims should have been approved, the recovery is a much greater amount than what they likely would have received had they prevailed at trial, the motion said.

The $11.8 million settlement amount will also be used to pay attorney fees and other administrative costs. The centers’ counsel are requesting one-third of the settlement amount in fees and up to $300,000 in expenses as well as $10,000 service awards for the two lead plaintiffs. The counsel’s fee request is less than the amount incurred on the lodestar in the case, according to the motion.

In the settlement, American Specialty Health also agreed to make certain business reforms, including trying to add more chiropractic associations or out-of-network providers to its Professional Affairs Health Advisory Committee and to offering more free continuing education programs to out-of-network and contracted providers.

 The centers had alleged in their suit that one of American Specialty Health’s practices for reviewing claims from certain out-of-network providers clashed with Cigna plan language and resulted in the arbitrary denial of some claims in violation of the Employee Retirement Income Security Act. But the companies disputed the claims, arguing, among other things, that many of the centers had failed to exhaust their administrative remedies.

 A representative for American Specialty Health declined to comment. Counsel and representatives for the remaining parties didn’t respond Wednesday to requests for comment.