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California Court of Appeal Affirms Grant of Summary Judgment Against Health Care Provider in Win for Managed Care Payors and Claims Administrators | Troutman Pepper

The California Court of Appeal, in a major win for managed care payors and claims administrators, affirmed a lower court decision granting summary judgment in favor of United Healthcare. ....

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Judge Declines Consolidation of Repricing Suits Against Cigna

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February 17, 2021
On Tuesday, the court issued an opinion in a class action brought by Pacific Recovery Solutions against Cigna Behavioral Health Inc. The opinion, issued in the Northern District of California, dealt with a motion to consolidate the case Summit Estate Inc. v. Cigna Health and Life Insurance with the larger Pacific Recovery Solutions case for ease of resolution. Both of the cases involve plaintiff patients and medical providers whose mental health bills had been repriced using a third-party entity, resulting in a very small provider payment and a very large patient responsibility.
When a medical provider does not have a negotiated contract giving insurance companies a discount from their billed rate, frequently an alternative pricing schema will be sought by the insurance company. In both of the cases before the court, Cigna sought a repricing discount from a third-party repricer, Viant. Viant was not contracted with any of the ....

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