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Did Cigna take advantage of a surge in COVID-19 hospitalizations to deny claims?

On January 21, Becker’s Payer Issues reported on a lawsuit recently filed by a New York resident against Cigna. The issue at hand: Cigna’s decision not to cover an emergency surgery that took place outside of the hospital setting in the midst of a surge of COVID-19 cases at the nearest hospital’s emergency department. Our take? It’s just the latest example of payors skirting their obligations to cover their members’ medical care, and leaving patients in the lurch in the middle of a global pandemic.

New York resident Dinah Nissen was bitten on her right cheek by a dog in mid-May. After a clinician at a local urgent care urged her to see a plastic surgeon immediately, Dinah was advised by an on-call surgeon at the closest hospital’s emergency department to have her surgery at his office, due to the high number of COVID-19 cases in the hospital at the time.

A month later, she received a $10,300 bill from Cigna stating that the surgeon was out of network, leaving Dinah on the hook for the sky-high medical bill. Even after the surgeon’s biller contacted Cigna to explain why the emergency surgery took place at the office rather than the hospital, Cigna maintained its denial.

In a year marked by a significant public health crisis, new data from ChangeHealthcare (yes, that’s the same ChangeHealthcare that UnitedHealthcare just bought), indicates that medical claims denials between June 2019-June 2020 rose 11% nationwide compared to a similar time period in 2016-2017. The regions with the highest denial rates—the Pacific Coast and the Northeast—just so happen to be the areas hit hardest by the first wave of COVID-19 outbreaks.

This story and the ChangeHealthcare data reflect the first part of 2020, which was—in retrospect—only the beginning of the huge COVID-19 surges we saw at the end of 2020. Our prediction is that we’re going to continue to see claims denials rise for the back half of 2020 as insurers do whatever they need to protect their bottom line.

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