ASCs win $4M settlement for Horizon underpayments — 5 insights

Written by Angie Stewart | February 01, 2019 | Print  |

A federal court awarded 183 surgery centers a $4 million settlement in a class action lawsuit against Horizon Blue Cross Blue Shield of New Jersey.

Five insights:

1. The class action alleged Horizon underpaid surgery centers for medical claims, in violation of the Employee Retirement Income Security Act.

2. In 2008, Horizon identified and nixed flawed methodology responsible for low reimbursements. However, Horizon denied the allegations set forth in the lawsuit.

3. The parties settled the dispute to avoid the cost of a trial.

4. Led by Barbara Edwards of Succasunna, N.J.-Roxbury Surgical Center, the class action may apply to any licensed ASC in New Jersey that provided out-of-network services to any Horizon member from Oct. 1, 2004, through Dec. 31, 2014.

5. Three of the class members opted out of their $4,545.61 portion of the settlement: Woodland Park, N.J.-based McBride Surgical Center, Woodland Park-based Gastroenterology Diagnostics of Northern New Jersey and Newark, N.J.-based Premier Surgical Pavilion. The final approval order and judgement did not elaborate on their reasons for opting out.

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