The initial suit came after Cigna denied claims from Advanced Physicians for the treatment of NFL players. The insurer claimed billed amounts were unusual, and eventually, Cigna found players visited the site from out of state to address work-related injuries that the plan did not cover, according to Law 360.
The court sided with Cigna after ruling plaintiff Advanced Physicians didn’t do everything they could to fight the claim denials before taking the matter to court.
In the judge’s opinion, correspondence between the insurer and provider was key, as the court ruled that Cigna did provide opportunity to review denied claims and Advanced Physicians did not make an effort to negotiate the benefits.
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