Class-Action Lawsuit Filed Against Cigna for Allegedly Denying Depression Treatment
Case Raises Questions of Bias Regarding Independent Review Organizations
September 9, 2015 08:00 AM EDT
LOS ANGELES, CA — (Marketwired) — 09/09/15 — A class-action lawsuit has been filed against Cigna by Psych-Appeal, Inc., in conjunction with Zuckerman Spaeder LLP, on behalf of mental health patients suffering from depression. The federal lawsuit alleges Cigna has categorically refused to cover Transcranial Magnetic Stimulation (TMS), a safe and effective treatment approved by the U.S. Food and Drug Administration.
“Although Medicare and numerous commercial insurers routinely cover TMS, Cigna has unjustifiably categorized this treatment as ‘experimental and investigational,'” said Brian Hufford, partner at Zuckerman Spaeder LLP. “By denying coverage for TMS and restricting patients from receiving potentially lifesaving treatment, Cigna is improperly elevating its own interests above the welfare of its members.”
The suit involves a 61-year-old woman who has tried multiple treatments for severe depression. In 2008, the FDA cleared TMS for patients who have failed to respond to psychotropic medications. TMS, unlike electroshock therapy, is performed on an outpatient basis without sedation and does not typically result in side effects such as memory loss.
The complaint also alleges that MCMC, LLC, an independent review organization directly contracted with Cigna to evaluate external appeals of the company’s TMS denials, rubber-stamps the insurer by relying on outdated clinical research.
“In California alone, at least 75 external appeals to other independent review organizations have recognized TMS as a valid evidence-based treatment for depression since 2011,” said Meiram Bendat, mental health attorney and founder of Psych-Appeal, Inc. “We expect this case to highlight the conflicts of interest that independent review organizations have when they are allowed to contract directly with insurers to evaluate claim denials.”
On Sept. 3, 2015, Psych-Appeal, Inc. and Zuckerman Spaeder LLP filed a similar class action complaint against Aetna and MCMC.
About Psych-Appeal, Inc.
Los Angeles-based Psych-Appeal, Inc. is a law firm exclusively dedicated to mental health insurance claims, advocating on behalf of patients, clinicians and treatment facilities to overcome insurer denials of treatment. For more information, visit www.psych-appeal.com.