Ten addiction-treatment providers and clinical laboratories based in California have filed a federal lawsuit against Cigna, alleging the insurer underpaid them by more than $12.8 million for covered care. The complaint was submitted to the U.S. District Court for the Central District of California on August 19, 2026.
The legal action covers services rendered to 83 patients between March 1, 2022, and March 15, 2026. According to the filing, the plaintiffs submitted approximately $15.3 million in covered charges but received only about $2.5 million, representing 16.4% of the total. Individual providers claim they received between 0% and 28.3% of their respective covered charges.
The plaintiffs include TML Recovery, Bohica Investments, Cardiff Health Services, Carlsbad Mental Health Services, Harbor Health, IMS Services, La Costa Recovery, San Diego Mental Health, Southern California Recovery Centers Oceanside, and Sunray Services. They named Cigna Corp. and several subsidiaries as defendants, including Cigna Health and Life Insurance Company, Cigna Healthcare of California, Connecticut General Life Insurance Company, and Evernorth Behavioral Health.
The dispute centers on Cigna’s Maximum Reimbursable Charge methodologies used to determine payments to out-of-network providers. The lawsuit alleges that Cigna linked billing codes for substance-use-disorder services to rates for psychiatric hospitals and skilled nursing facilities, despite Medicare not having applicable rates for the specific services provided.
The complaint also claims that Cigna’s agreements with self-funded employer health plans created financial incentives to reduce payments, including cost-containment fees ranging from 27% to 29% of the difference between billed and paid amounts.
Additionally, the providers allege that Cigna sent claims to MultiPlan, now known as Claritev, for repricing using the Viant and Data iSight databases. While Claritev and Viant are not defendants in this case, the filing states that MultiPlan received between 9% and 12% of the difference between billed and paid amounts.
