Ten addiction treatment providers allege Cigna paid roughly 16% of covered charges while earning fees linked to the unpaid difference. The allegation sits at the center of a complaint filed Aug. 19, 2026, in the US District Court for the Central District of California.
The plaintiffs include ten out-of-network substance use disorder treatment centers and clinical laboratories operating in California.
They sued Cigna Corporation, Cigna Health and Life Insurance Company, Cigna Healthcare of California, Inc., Connecticut General Life Insurance Company, Evernorth Behavioral Health, Inc., and Cigna Health Management, Inc. Their claims involve 83 patients treated between March 1, 2022, and March 15, 2026.
According to the complaint, Cigna paid individual providers between 0% and 28.29% of covered charges. Across all ten plaintiffs, payments reached 16.42%, or $2.52 mn against $15.34 mn in aggregate covered charges.
The providers say $12.82 mn remains unpaid. A court has not tested those allegations.
According to the filing, every plan involved used one of two reimbursement methods under Cigna’s Maximum Reimbursable Charge, or MRC, framework.
Under MRC 1, Cigna would pay the lower of the provider’s normal charge for a similar service or a percentile drawn from charges submitted by providers offering the same service in the same geographic area. Cigna selected the database used for the calculation, according to the complaint.
MRC 2 used what the filing describes as a Medicare-like rate. Under this method, payment would equal the lower of the provider’s normal charge or a percentage of a Cigna schedule built using a methodology similar to Medicare reimbursement for comparable services in the same market.
The plaintiffs argue MRC 2 never offered a workable reimbursement route for their services.
During the period covered by the lawsuit, the complaint says Medicare had no reimbursement rates for services delivered by substance use disorder treatment facilities. Without a Medicare rate, the plaintiffs argue, Cigna lacked a Medicare-like benchmark for those services.
The filing points to Cigna’s published myCigna Legal Disclaimer. Cigna’s own language says services without a comparable Medicare rate should fall back to the lower of the provider’s normal charge or the MRC Option I methodology based on the 80th percentile of billed charges.
On the plaintiffs’ reading, either reimbursement path should therefore have produced payment at the full billed charge or a reasonable and customary rate. They allege Cigna paid far less.
Instead, the complaint says Cigna relied on a code cross-walk.
Detoxification and residential treatment allegedly matched codes used for inpatient psychiatric hospitals. Partial hospitalization, intensive outpatient treatment and outpatient care allegedly matched codes associated with skilled nursing facilities and general behavioral health counselors.
The plaintiffs argue those comparisons paired different providers with different services.
The complaint includes excerpts from Cigna emails and internal memoranda attached as exhibits. It says earlier litigation involving the same lead plaintiff led to those documents becoming public.
An April 2015 email chain, as described in the filing, discussed a problem with using Medicare rates for substance abuse treatment because Medicare lacked such rates. The email also stated Cigna had been reimbursing those claims at billed charges.
Material dated July 2015 said Cigna should not develop the charges internally and referenced earlier litigation involving Ingenix over out-of-network reimbursement.
- Another July excerpt called for an external party, such as Milliman, to develop acceptable Medicaid or other reimbursement charges. Separate material from the same month included a proposed list of out-of-network facilities in Florida and California for focused review.
- By August 2015, another internal excerpt cited in the complaint reported an almost 90% reduction in paid claims compared with two weeks earlier.
The complaint also alleges Cigna reported in November 2015 a reduction in payments on out-of-network intensive outpatient claims, falling from $13.6 mn in June to $3 mn in August.
Those documents form part of the plaintiffs’ interpretation of Cigna’s reimbursement strategy. No court has ruled on their meaning in this case.
For employers running self-funded health plans, the complaint also focuses on Cigna’s compensation structure.
The filing alleges Cigna receives two forms of compensation under Administrative Services Agreements with plan sponsors. One consists of a per-member, per-month administrative fee.
The second involves a cost containment fee, generally equal to 27% to 29% of net savings, according to the complaint. The plaintiffs define net savings as the difference between a provider’s billed amount and the amount Cigna paid.
The complaint says Cigna then sent claims to MultiPlan for repricing through Viant and Data iSight databases. MultiPlan allegedly received 9% to 12% of the same difference between billed charges and final payment.
The filing identifies MultiPlan as Claritev, Inc., formerly MultiPlan, Inc. Viant, Inc. also appears as a non-party. Neither company is a defendant in the lawsuit.
The plaintiffs argue the economics created a direct link between lower provider reimbursement and higher fees.
According to their calculations, Cigna’s cost containment compensation approached twice the amount paid to the plaintiffs for substance use disorder treatment. MultiPlan’s alleged fee equaled roughly half of the amount providers received.
The plaintiffs also cite a March 2024 order from earlier litigation involving the same lead plaintiff. In the earlier case, the court said Cigna’s percentage-based cost containment compensation created a degree of skepticism because the structure presented an incentive to under-reimburse claims and increase savings fees.
Under the health plans described in the filing, members unable to locate an in-network provider for a covered service could obtain authorization for out-of-network care. Once authorized, the plans allegedly covered treatment at the in-network benefit level, equal to 100% of covered charges after any remaining deductible, copay or coinsurance.
The plaintiffs say Cigna lacked an adequate network of substance use disorder providers and clinical laboratories. They also allege Cigna preauthorized the treatment involved in the case.
A separate claim focuses on the Mental Health Parity and Addiction Equity Act. The providers allege Cigna used different reimbursement methods for out-of-network substance use disorder treatment than for medical and surgical services.
The complaint cites the 2024 MHPAEA Report to Congress. The report identifies different methods for determining reimbursement rates for mental health and substance use disorder providers compared with medical and surgical providers among financial and treatment limitations reviewed under federal parity rules.
The filing also references a February 2024 settlement described in the report’s appendix.
The agreement involved the US Department of Labor’s Employee Benefits Security Administration and an ERISA-covered Taft-Hartley multiemployer health plan using Cigna Health and Life for plan administration.
According to the complaint, EBSA found the fund used different processes and evidentiary standards when evaluating network adequacy for medical and surgical care compared with mental health services.
The complaint characterizes the special investigations process as serving Cigna’s financial interests rather than conducting a genuine claims review. Cigna has not had those allegations tested in court.
According to the plaintiffs, the forms omitted notices of legal rights required under ERISA, including appeal rights. They also allege Cigna never raised anti-assignment provisions during claims processing.
