Cigna Wins Emergency Room Billing Suit: What It Means for Your Injury Claim

Emergency room visits can be financially devastating, especially when insurance companies deny or underpay claims. Recently, Cigna, one of the nation’s largest health insurers, won a significant legal battle regarding emergency room billing. A recent ruling favored Cigna in a case concerning out-of-network emergency services, allowing them to potentially engage in balance billing where it doesn’t violate state or federal law. Understanding the implications of this ruling is crucial, especially if you have an injury claim involving emergency medical treatment. This blog post will break down the lawsuit, explain what it means for your injury claim, and provide guidance on protecting your rights.

The Cigna Emergency Room Billing Lawsuit Explained

In July 2025, the Sixth Circuit Court of Appeals sided with Cigna in a case brought by two Tennessee hospitals, Saint Francis Hospital and Saint Francis Hospital-Bartlett. The hospitals alleged that Cigna underpaid them for out-of-network emergency services provided to Cigna members. The hospitals argued that Cigna had a “quasi-contractual obligation” to pay the reasonable value of their services, citing federal and state laws that require hospitals to treat emergency patients and insurers to cover emergency care.

The court, however, disagreed. The three-judge panel found that Cigna had no contractual obligation to provide full coverage for out-of-network emergency services, as long as its refusal didn’t violate state or federal law. The court emphasized that the Affordable Care Act (ACA) requirement for insurers to provide “coverage” for emergency services doesn’t mandate paying the full cost. This ruling allows Cigna to engage in “balance billing,” where they charge patients the difference between the cost of care and the amount the insurer is willing to cover.

How Cigna’s Win Impacts Your Injury Claim

Cigna’s victory in this lawsuit has several potential implications for your injury claim, particularly if you received emergency medical treatment:

Increased Risk of Balance Billing: Cigna may be more likely to balance bill you for out-of-network emergency services. This means you could receive a bill for the remaining amount after Cigna pays its portion, potentially leading to significant out-of-pocket expenses.
More Scrutiny of Emergency Room Claims: Insurers, including Cigna, may increase scrutiny of emergency room claims, potentially denying or underpaying claims they deem unnecessary or not genuinely emergent.
Potential for Reduced Settlements: If you’re pursuing a personal injury claim, the amount you can recover may be affected. If Cigna successfully reduces its payments for your emergency medical treatment, it could impact the overall value of your claim.
Complexity in Negotiations: Negotiating settlements with insurance companies can become more complex. You may need to fight harder to recover the full value of your medical expenses, especially if balance billing is involved.

What You Should Do If You Receive a Balance Bill

If you receive a balance bill from a hospital or emergency room after Cigna has paid its portion, here’s what you should do:

Review Your Insurance Policy: Understand your policy’s coverage for emergency services, including out-of-network care. Look for clauses related to balance billing and cost-sharing.
Contact Cigna: Inquire why the claim wasn’t fully covered and if balance billing is permitted under your plan.
Negotiate with the Hospital: Contact the hospital’s billing department and attempt to negotiate the bill. Hospitals may be willing to reduce the amount, especially if you can pay a portion upfront.
File an Appeal: If you believe the balance bill is unfair or violates your policy, file an appeal with Cigna. Provide documentation supporting your case, such as medical records and policy details.
Seek Legal Advice: If negotiations and appeals fail, consult with a personal injury attorney. An attorney can review your case, advise you on your legal options, and represent you in negotiations or litigation.

Protecting Your Rights in Injury Claims Involving Emergency Care

Navigating injury claims involving emergency room billing can be challenging. Here are some steps you can take to protect your rights:

Document Everything: Keep detailed records of all medical treatments, bills, and communications with insurance companies and healthcare providers.
Understand Your Insurance Coverage: Familiarize yourself with your health insurance policy, including coverage for emergency services, deductibles, co-pays, and out-of-network provisions.
Seek Immediate Medical Attention: If you’re injured, seek immediate medical attention, especially if you experience severe symptoms. Don’t delay treatment due to concerns about billing.
Know Your Rights Under EMTALA: The Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals to provide emergency medical screening and stabilization to anyone who needs it, regardless of their ability to pay or insurance status.
Consider “Med-Pay” Coverage: If you have “Med-Pay” coverage as part of your auto insurance policy, it can help cover medical expenses regardless of who was at fault in the accident.
Consult with a Personal Injury Attorney: If you’re injured due to someone else’s negligence, consult with a personal injury attorney as soon as possible. An attorney can protect your rights, negotiate with insurance companies, and help you recover the compensation you deserve.

The No Surprises Act: A Potential Shield

The No Surprises Act, which went into effect in 2022, offers some protection against surprise medical bills for out-of-network emergency care. This federal law generally prevents balance billing in emergency situations and requires insurers and providers to resolve payment disputes through an independent dispute resolution (IDR) process. However, the law has limitations and may not apply in all situations.

Navigating the Complexities of Emergency Room Billing

Emergency room billing is a complex area, and Cigna’s recent legal victory adds another layer of complexity. Understanding your rights, documenting everything, and seeking professional help when needed are crucial steps in protecting yourself from unfair billing practices and maximizing your injury claim. If you’ve been injured and received emergency medical treatment, don’t hesitate to consult with a personal injury attorney to ensure your rights are protected and you receive the compensation you deserve.