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.