Southern Regional Medical Center is suing Cigna in Fulton County Superior Court, alleging that Cigna did not fully reimburse SRMC for medically-necessary services as an out-of-network provider.

According to the complaint, the nonprofit SRMC, which is part of the Prime Healthcare Foundation, alleges that Cigna Health and Life Insurance Company, which is based in Connecticut, and Cigna Healthcare of Georgia, Inc., which operates in Fulton County, failed to pay reimbursements for insured patients “from 2019 to May 2020” for “hundreds of patients enrolled in health benefit plans issued and/or administered by Defendants with the understanding and expectation that Defendants would pay for those services.”

The suit also names ten John or Jane Does, “whether individual, corporate, associate, or otherwise,” who are “currently unknown to SRMC” as of the filing.

Instead, SRMC alleges, Cigna “systematically failed and refused to fully and properly pay SRMC for the reasonable value of the services that SRMC provided to Defendants’ members for Defendants’ benefit and/or on Defendants’ behalf.”

SRMC noted that “In a medical emergency…a patient often does not have the time, opportunity, or ability to choose an in-network hospital; instead, the patient often goes (or is taken) to whichever hospital is the closest.”

SRMC says it turned in individual claims for such patients to Cigna, and that Cigna paid some of them, “but for hundreds of SRMC’s claims, Defendants paid SRMC far less than the reasonable value for those services.”

SRMC is suing for “the reasonable value of the medically necessary hospital services that it provided” to Cigna members, “the exact amount to be proven at trial, plus interest.” SRMC also is suing for “restitution and/or damages” plus interest for Cigna’s alleged unjust enrichment, and damages plus interest for Cigna’s alleged breaches of implied contracts, and court costs.

The case number is 2023CV383450. SRMC is represented by Baker Hostetler.

Robin Kemp is executive editor and CEO of The Clayton Crescent, which she founded in 2020. She has worked for Gambit, CNN, The Weather Channel, Clayton News, Henry Herald, and numerous freelance outlets....

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