On Friday a case was filed in the Northern District of Illinois by Advanced Physical Medicine of Yorkville, Ltd. against Cigna Healthcare of Illinois and Cigna Health Management. The case is regarding failure to pay for medically necessary services.
The patient approached the plaintiff for chiropractic treatment. The plaintiff sent a request to Cigna for a series of 27 visits. The defendants approved 18 visits, but denied coverage for the remaining nine visits, stating that the condition being treated was chronic and that response to the first round of treatment was needed as the condition should require less care. The plaintiffs said they submitted three rounds of internal appeals to Cigna, all of which were denied as not medically necessary and claiming that the records did not include object measurement of improvement.
The plaintiffs are suing for recovery of benefits and reprocessing of the denied final nine visits. Plaintiffs are represented by the Law Offices of McLaughlin & Associates PC.