ASCs seek approval for $4M settlement with Horizon over low reimbursement claims — 6 insights

A group of more than 180 ASCs requested a federal court's final approval of a $4 million settlement with Horizon Blue Cross Blue Shield of New Jersey, Law360 reports.

Here are six insights:

1. The suit, which was initiated 13 years ago regarding Horizon's out-of-network reimbursement practices, accuses the payer of making improperly low reimbursements on medical claims in violation of the Employee Retirement Income Security Act. The suit includes two subclasses — Navigant and the Student Employee Health Plan.

2. The centers have already received more than $150 million through lawsuits over reimbursements. The Student Employee Health Plan subclass will receive an additional $3 million under the settlement, and the Navigant subclass will receive $1 million.

3. Horizon recognized an error in a claims system as a result of the litigation and did away with the faulty methodology responsible for the low reimbursements in 2008, according to Law360. The proposed class members have since received $160 million in increased reimbursements.

4. The settlement asks for $9 million in attorneys' fees and expenses and $5,000 for Barbara Edwards, the class representative and the insolvent Succasunna, N.J.-based Roxbury Surgical Center's trustee.

5. One case against Horizon regarding its out-of-network reimbursement practices was dismissed after the center leading the suit entered Horizon's network. A similar case was administratively terminated.

6. In a third similar case, Horizon and Glen Ridge (N.J.) Surgicenter reached settlement. Other centers involved in the suit were allowed to move forward with their claims and North Jersey Ambulatory Surgical Center became the class representative, but it eventually dropped its claims.

"This settlement provides a fair resolution that compensates the class members appropriately for their services," a Horizon spokesperson told Law360.

More articles on surgery centers:
How New Jersey's Healthcare Facilities Planning Act relates to ASCs — 4 quick facts
Congressional action on Stark Law is critical to developing value-based healthcare
7 things for ASC leaders to know for Thursday — June 28, 2018

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