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Thirty-three anesthesia providers sued Aetna and Cigna under the federal No Surprises Act on Monday, alleging that the insurers failed to pay around 1,500 claims totaling more than $4 million. The lawsuit, filed in Connecticut District Court, alleged systemic issues of failure to pay medical claim determinations.
The plaintiffs, referred to collectively as NorthStar, are mostly backed by private equity. They claim that the two insurers "frequently" failed to pay the determinations in the act’s independent dispute resolution process, adding they often do not pay within 30 days after the resolutions have been determined.
“The No Surprises Act is unambiguous that independent dispute resolutions determinations are binding and payable within 30 days,” the lawsuit said. “Aetna or Cigna violates the NSA whenever it waits 31 days or more. It is fundamentally unfair for these multinational conglomerates to withhold fair payment, force NorthStar to seek relief in independent dispute resolution and then shortchange NorthStar when NorthStar prevails before the independent dispute resolution entity.”
The plaintiffs also allege violation of the Connecticut Unfair Trade Practices Act and the Connecticut Unfair insurance Practices Act.
"These general business practices deprive NorthStar of the money NorthStar has earned, force NorthStar to expend resources trying to collect the money and ultimately prevent NorthStar from investing resources in patient care," the lawsuit said. "The harm is not merely financial; Aetna and Cigna force NorthStar to divert its resources away from patient care."
The number of independent dispute resolutions has soared since the No Surprises Act went into effect on Jan. 1, 2022.
"Congress designed the No Surprises Act to protect American patients from exorbitant, unfair billing practices, not to pad private equity-backed provider profits on the backs of patients," Aetna spokesperson Phillip Blando said, according to Law.com. "Research clearly shows that some provider groups are abusing the process intended to resolve surprise billing disputes. These tactics saddle American employers and consumers with billions of dollars in unnecessary costs."
The judicial system still is ironing out the specifics of lawsuits filed under the No Surprises Act to enforce the awards. Although the U.S. Court of Appeals for the Fifth Circuit ruled that providers must undergo an administrative process with the U.S. Department of Health and Human Services, conflicting opinions in Connecticut and New York have allowed No Surprises Act lawsuits to move forward.
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