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The Association of American Physicians and Surgeons (AAPS) filed suit in U.S. District Court on Friday asking the Court to block California AB 72, the so-called “Surprise Medical Bill” law signed last month by Governor Jerry Brown.

“This new law gives insurance bureaucrats the power to decide what out-of-network physicians can be paid for life-saving medical care,” said AAPS General Counsel Andrew Schlafly. “Independent doctors, already under attack from all directions, could be forced to shut their doors. Patients are already having trouble finding doctors, and thi...

A federal district court found that Cigna Healthcare abused its discretion, and thus was liable under section 502(a)(1)(B) of ERISA, when its primary motivation for refusing to pay a hospital’s claims was to enhance its leverage in negotiations to bring the hospital into its provider network. While Cigna argued that it had a valid justification for refusing to pay the hospital’s claims because of the hospital’s practice of forgiving balances owed by Cigna’s members, the court found that Cigna’s interpretation of its plan language was legally incorrect, and that the...

The U.S. District Court for the Southern District of Texas recently ruled on motions for summary judgment by both parties in North Cypress Medical Center Operating Company, Ltd v. Cigna Healthcare, holding that Cigna’s application of its “fee forgiveness” protocol (the “Protocol”) in the administration of benefit claims for medical services rendered by North Cypress was legally incorrect and constituted an “abuse of discretion” under ERISA. Cigna performed claims administration services as a third-party service provider for employer-sponsored, self-funded group med...

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