Ten addiction treatment providers say Cigna paid them about 16% of their covered charges - and earned a fee on the gap.
That is the central allegation in a complaint filed on August 19, 2026 in the US District Court for the Central District of California.
The plaintiffs are ten out-of-network substance use disorder treatment centers and clinical laboratories operating in California. They are suing 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. The claims cover 83 patients treated between March 1, 2022 and March 15, 2026.
According to the filing, Cigna paid each provider somewhere between 0% and 28.29% of its covered charges. As a group, the complaint alleges, they received 16.42% - $2,519,077.43 against aggregate covered charges of $15,338,175.60. The filing puts the balance it says is still owed at $12,819,098.17. None of it has been tested in court.
The dispute comes down to how those payment amounts were calculated.
The complaint says every plan involved used one of two reimbursement methods, both of which it says Cigna brands “Maximum Reimbursable Charge,” or MRC. Under MRC 1, the filing states, Cigna was meant to pay the lower of two numbers: the provider’s normal charge for a similar service, or a percentile of charges made by providers of that service in the geographic area where it is received, compiled in a database Cigna has selected. Under MRC 2 - what the complaint says Cigna refers to as a “Medicare-like” rate - Cigna was meant to pay the lower of the provider’s normal charge, or a percentage of a schedule Cigna has developed based on a methodology similar to one Medicare uses for comparable services in that market.
The plaintiffs allege the second route was never actually available to them. During the relevant period, the complaint states, Medicare had no rates for the services that substance use disorder treatment facilities provide. No Medicare rate, the argument runs, means no Medicare-like schedule to work from.
The filing points to Cigna’s own published language on that scenario. It quotes the myCigna Legal Disclaimer as explaining that where no comparable Medicare rate exists, “the MRC is determined based on the lesser of [] the health care professional or facility’s normal charge for a similar service or supply; or [] the MRC Option I methodology based on the 80th percentile of billed charges [i.e., an R&C rate].” So under either method, the complaint argues, the providers were owed either their full billed charges or a reasonable and customary rate. It alleges Cigna paid far below that.
What happened instead, according to the filing, was a code cross-walk. The complaint alleges detox and residential treatment were matched to codes used by inpatient psychiatric hospitals, while partial hospitalization, intensive outpatient and outpatient care were matched to codes used by skilled nursing facilities and general behavioral health counselors - in each case, it alleges, different providers delivering different services.
The complaint reproduces excerpts from Cigna emails and memoranda, which it attaches as exhibits. It alleges these documents were unsealed in earlier litigation involving the same lead plaintiff.
An April 2015 chain quoted in the complaint reads: “Our problem is we’re looking to Medicare rates to reimburse substance abuse. Since there are no Medicare rates for substance abuse, we’ve been reimbursing at billed charges.”
A July 2015 excerpt quoted in the filing reads: “We cannot develop these charges internally (think of when Ingenix was sued for creating out of network reimbursements).” A separate line from the same July 2015 material, quoted in the complaint, reads: “We need someone (external to Cigna) to develop acceptable Medicaid or otherwise acceptable charges (like Milliman).” Another July 2015 excerpt, listed under next steps for Florida and California, reads: “Create a hit list for OON facilities.”
By August 2015, an excerpt quoted in the complaint reads: “For this week, we’re on pace for nearly a 90% reduction in paid claims compared to just 2 weeks ago. But we’re not out of the woods yet.” The complaint further alleges that in November 2015, Cigna touted that it had reduced the amount paid on out-of-network intensive outpatient claims from $13.6 million in June to $3 million in August. The plaintiffs’ characterization of these documents is their own, and no court has ruled on what the excerpts mean.
For anyone running an employer health plan, though, the part worth reading twice is the fee structure the complaint describes.
On self-funded, employer-sponsored plans, the filing alleges Cigna is compensated two ways under its Administrative Services Agreements with plan sponsors: a per-member, per-month fee, and a cost containment fee “generally calculated as 27 to 29% of the ‘net savings,’” which the complaint describes as the difference between the amount billed by the provider and the amount paid by Cigna. The complaint alleges Cigna then routed claims to MultiPlan for repricing using its Viant and Data iSight databases, and rewarded MultiPlan with a fee of 9-12% of that same difference.
MultiPlan - identified in the complaint as Claritev, Inc, formerly known as MultiPlan, Inc. - and Viant, Inc. are described in the filing as non-parties. Neither is a defendant in this action.
The plaintiffs put the arithmetic plainly. The complaint alleges Cigna’s fee for slashing the providers’ bills was “nearly double what Cigna paid to Plaintiffs for providing the SUD treatment,” and that MultiPlan was rewarded with a fee amounting to “half of what Plaintiffs were paid.” The filing argues those fees track the size of the reduction rather than the accuracy of the price - that neither party, on its account, is compensated for getting the number right.
The complaint also cites a March 2024 order from earlier litigation involving the same lead plaintiff, in which the court found that the percentage of fees Cigna receives in exchange for its cost containment program “gives rise to a certain ‘degree of skepticism,’ as it could incentivize Cigna to under-reimburse claims in order to earn a higher percentage of savings.” That finding was made in a different case and decides nothing in this one.
Alongside the pricing claim, the plaintiffs run a network adequacy theory. Under the plans described in the complaint, if an insured cannot locate an in-network provider in their area for a covered service and obtains authorization to go out of network, benefits are covered at the in-network level - 100% of covered charges, less any applicable and remaining in-network deductibles, copays or coinsurance. The filing alleges Cigna’s network of substance use disorder providers and clinical laboratories was inadequate, that Cigna preauthorized the treatment anyway, and that it was therefore required to pay at that level.
Separately, the complaint alleges the reimbursement approach violated the Mental Health Parity and Addiction Equity Act by treating out-of-network substance use disorder providers differently from medical and surgical providers. It quotes the 2024 MHPAEA Report to Congress, including a passage listing “disparate ways of determining reimbursement rates for MH/SUD providers as compared to M/S providers” among the treatment limitations the law addresses.
The filing also references a February 2024 settlement agreement, described in that report’s appendix, between the US Department of Labor’s Employee Benefits Security Administration and an ERISA-covered Taft-Hartley multiemployer health plan that had contracted with Cigna Health and Life. According to the complaint, that agreement resolved EBSA determinations that the fund used different, non-comparable processes and evidentiary standards to evaluate the adequacy of its medical/surgical and mental health networks.
On claims handling, the complaint alleges the providers were placed on pre-payment review and program integrity audits, and that different Cigna departments requested the same documents from them repeatedly. It characterizes the special investigations unit’s work as “nothing more than a façade, designed to create the illusion of thoroughness while serving Cigna’s financial interests.”
The filing also alleges that the explanation of payment forms sent to the providers left out the notice of legal rights required under ERISA, including the right to an appeal; that no anti-assignment provisions were ever raised during the claims process; and that the providers were never notified of any obligation to exhaust internal appeals before litigating. On that basis, the plaintiffs argue any exhaustion requirement was waived, does not apply, or would have been futile. Each of these points is contested territory - the plaintiffs’ position, not a finding.
The complaint pleads four causes of action, all against all defendants: claims for plan benefits under ERISA, 29 U.S.C. §1132(a)(1)(B); breach of written contract covering the non-ERISA plans; breach of oral contract; and promissory estoppel.
The prayer asks the court for compensatory, general and special damages, statutory and prejudgment interest, disgorgement of all cost containment fees Cigna received under its Administrative Services Agreements for the adjudication of these claims, attorneys’ fees, costs, and injunctive and equitable relief. The plaintiffs have demanded a jury trial.
The allegations set out in the complaint have not been tested in court. No defendant has filed a response, and no court has ruled on any of the claims.
