Surgical Center – “

Surgical Center – “CIGNA Screwed Us!”

CIGNA paid Florida surgical center $75,000 for an operation done at their facility. But the surgical center wants $434,000.00 more…………….

Florida ASC sues Cigna for $434K spine reimbursement

Marcus Robertson – Tuesday, January 25th, 2022

Melbourne, Fla.-based Surgery Center of Viera filed a lawsuit Jan. 20 in Florida Middle District Court in Orlando against Cigna and Strategic Enterprise Solutions.

The ASC is seeking $434,000 for reimbursement of spinal surgery to treat a patient with “chronic (and progressively worsening) debilitating back pain,” according to court documents. The center alleges Cigna determined the surgery medically necessary but only reimbursed about $75,000 on a billed amount of $405,373.

Surgery Center of Viera said Cigna allegedly used a “mystery re-pricing program” in calculating the reimbursement amount, rather than a previously established re-pricing contract the center says should have resulted in an 80 percent reimbursement rate, or $350,693.

The ASC also alleges Cigna shirked a legal responsibility to produce applicable records related to the reimbursement and its calculation.

If true, the center said Cigna would be on the hook for a $110 per day penalty from the federal government beginning Feb. 12, 2018, totaling $158,180 as of Jan. 20, when the lawsuit was filed.



Source

Hippo Sighting Report

Help us out, we really appreciate it.

Help contribute to our research, and let us know if you have seen similar situations that we may have missed. Our team will review the details you provide and add to our main list once we verify the information.

stay informed

Subscribe and get the updated Hippo List.

Get notified when we release our updated lists by email.

Make a Donation

Thank you for subscribing!

We will send you an email to confirm your details.  Welcome aboard!

Thanks for sending us your report.

We will review your information, and publish in on our list once we validate the details.