Texas has fined Cigna $600,000 for failing to comply with multiple independent claims dispute resolution requirements under state law.
Since 2020, Texas has prohibited surprise billing for most out-of-network claims and has offered a mediation and arbitration system for payers to settle bills with providers.
"Cigna struggled to keep up with its IDR requests in late 2022 through 2023," Texas' insurance commissioner wrote June 6. "The companies failed to meet multiple statutory and rule-based timelines for a significant portion of its IDR requests."
Despite the state's offer to train Cigna and explain the compliance issues, the problem did not improve by October 2023. The state required Cigna to develop and implement a corrective action plan by 2024, which it failed to do.
Since then, Cigna said "it has properly assigned resources to its IDR program" and will achieve full compliance by August 15.
"Cigna represents that it will continue to implement additional controls and fully monitor its IDR process for full compliance," the state wrote. "Cigna will timely alert TDI of any systemic or trending issues."