N.J. doctors and Horizon reach settlement in reimbursement lawsuit

NEWS IN BRIEF — Posted Nov. 27, 2006

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New Jersey physicians who sued the state's Blues plan won't receive any reimbursements under a proposed settlement agreement. However, Horizon Blue Cross Blue Shield of New Jersey has agreed to "continue significant business practice improvements ... to increase transparency in payment of claims," the HMO and the doctors said in a joint statement.

Changes Horizon agreed to include:

  • Making fee schedules available on a CD-ROM or electronically.
  • Giving participating physicians 90 days notice of material changes to its contracts, policies and procedures.
  • Reducing fees no more than once a year, if at all.
  • Recovering overpayments to physicians no more than 18 months after the original payment.
  • Revoking a determination of medical necessity only with evidence of fraud, error or material change in the patient's condition.

Horizon also agreed to pay the physicians $6.5 million in attorney's fees. If the court approves the Oct. 16 settlement, it would end a class-action lawsuit that accuses the HMO of routinely delaying and underpaying doctors' claims. Horizon did not admit any wrongdoing. About 40,000 doctors are part of the settlement. A final hearing in the Essex County Superior Court is scheduled for Dec. 20.

The settlement does not preclude doctors who are involved in a separate lawsuit against Horizon, brought by the Medical Society of New Jersey, from receiving damages.

Note: This item originally appeared at

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