Blue Cross and Blue Shield under Fire, Plaintiff Attorneys Hit With Reduced Fees

In 2007, Horizon Blue Cross Blue Shield of New Jersey was involved in a class action lawsuit filed by a group of nine medical specialists; including podiatrists and ophthalmologists. The medical specialists claimed that Blue Cross Blue Shield class action lawsuit stemmed against Horizon Blue Cross Blue Shield because of denied insurance claims that were considered “medically necessary” treatment for patients.  The medical specialists also contended that following an appeal process, which required a significant administrative expense, the insurance company very slowly paid the doctors for the patients’ services.

This lawsuit, known as Sutter v. Horizon Blue Cross Blue Shield of New Jersey, Esx-L-385-02, resulted in Horizon agreeing to settle the case. The provisions in the settlement, included:

• Financial compensation of approximately $1750.00 per physician over a five year period.
• Provision for the physician to reject accepting any new  Horizon patients.
• Published a fee schedule that physicians’ administrators can view online to determine patient benefits.

Horizon also wished to receive payment from the physicians for any over payments that the physicians received. Most recently, Superior Court Judge Stephen Bernstein reduced the award to the plaintiff attorneys from $6.5 million to $4.3 million.

The idea behind the Sutter v. Horizon Blue Cross Blue Shield of New Jersey lawsuit was to make billing reform fair and reasonable.  Yet, the Horizon participants were not awarded any benefits in this class action lawsuit. Horizon patients may be turned away by physicians and those affected by the slow paying of medical expenses, may possibly have poor credit ratings because the bills took so long to pay. It appears that the biggest advantage in the outcome of the lawsuit is that physicians won’t need to dedicate administrative time for Horizon patient claim filing. This is valuable to physicians since many are suffering through difficult economic times.

Last year, another settlement was approved in federal district court in Miami. It is a similar case entitled Love v. Blue Cross Blue Shield Association, 03-Civ.21296. In this case, the class action participants received monetary benefits, not just equitable relief as provided in the Sutter case.

If you feel you have experienced improper medical billing or have been denied medical insurance claim reimbursement, consider contacting Burton Padove, Indiana lawyer,  for a free consultation at (219) 836 2200.