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The class-action lawsuit, filed Monday in federal court in Sacramento, says Cigna Corp. and Cigna Health and Life Insurance Co. rejected more than 300,000 payment claims in just two months last year.
“UHC denied my claim, and I paid $1,400 out of pocket,” they said. “I'm one of the lucky ones. Can’t imagine how people would feel if that happened for critical or life-saving care.”
In January 2010, Cigna received the JD Power award for customer service for all of its call centers for the fourth time in a row. [50] In 2011, the California Nurses Association determined that Cigna denies roughly 39.6% of all claims (compared to competitors such as Aetna who denied about 5.9% of all claims in the same time frame). [51]
The settlement, reached on Friday, includes a payment of about $172 million by Cigna. Cigna said it also will enter into a corporate integrity agreement with the U.S. Office of Inspector General.
As of 2023, PBMs managed pharmacy benefits for 275 million Americans and the three largest PBMs in the US, CVS Caremark, Cigna Express Scripts, and UnitedHealth Group’s Optum Rx, make up about 80% of the market share covering about 270 million people [4] [5] with a market of almost $600 billion in 2024. [6]
Express Scripts Holding Company is a pharmacy benefit management (PBM) organization. In 2017 it was the 22nd-largest company in the United States by total revenue as well as the largest pharmacy benefit management (PBM) organization in the United States. [2]
The facts that had been established and were in the record for purposes of the Supreme Court decision were that Mrs. Calad had had a hysterectomy in a CIGNA-approved Hospital, and as Administrator of Mr. Calad's employer's health plan, a CIGNA nurse had preapproved 1 night's hospital stay for the procedure. Mrs.
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