Provider claims insurer not fully reimbursing for services

Kelly Holleran Jul. 9, 2009, 3:00am

A Texas healthcare provider is challenging health insurance companies that are allegedly refusing to fully reimburse it for its services.

Quality Infusion Care Inc., which is licensed as a pharmacy in the state of Texas, filed a lawsuit June 26 in Jefferson County District Court against Cigna Healthcare of Texas Inc. and Cigna Corp.

Quality Infusion contends it treated patients and sent a reasonable bill to their health insurance companies, but the companies either refused to pay the bills or submitted payments for an unreasonable rate.

Causes of action include breach of implied contract and fraud.

According to the complaint, the defendants used a database known as Ingenix and other methods to fraudulently "set" rates well below what is usual and customary.

Quality Infusion is seeking an unspecified judgment, plus pre- and post-judgment interest, costs and other relief the court deems just.

Robert D. Green of Robert D. Green and Associates in Houston will be representing the plaintiff.

The case has been assigned to Judge Bob Wortham, 58th District Court.

Jefferson County District Court case number: A184-403.

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