NJ BCBS Pays $8 Million for Holding Claims

A State of New Jersey Department of Banking & Insurance class action suit against Horizon Blue Cross Blue Shield (BCBS) of New Jersey has been settled out of court. The Blues plan has agreed to pay approximately $8 million in restitution for allegedly delaying payment of claims for which the insurer was the secondary payer to Medicare. The state department alleged that Horizon was setting the claims aside until it could ascertain whether a claim stemmed from a preexisting condition.

According to American Medical News, Horizon has agreed to reimburse members and physicians for the claims in question, with 12 percent interest, by Oct. 1. Claims under $50 will be reimbursed by Horizon but the checks will be distributed by the state. Horizon also was ordered to pay a 500,000 fine to the state.

Horizon did not admit to any wrongdoing, amednews reporter Emily Berry said, but has agreed to revise its practices for handling claims from Medicare beneficiaries for whom it provides secondary coverage.

This is the second class action suit New Jersey has filed against Horizon in six months. According to ClassActionLawsuitsintheNews, the insurer paid $22 million in October 2010 to settle a class action lawsuit for allegedly failing to promptly pay out-of-network ambulatory surgery centers (ASCs).

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2 Responses to “NJ BCBS Pays $8 Million for Holding Claims”

  1. Marilyn says:

    I hope this spreads across the country to all the Blues. Whatever happened to the prompt payment laws?

  2. Paul Thomas says:

    I switched to Horizon BCBSNJ this year. The information that prompted me to switch was not correct. It took one month before Horizon could find me in their system and just as long to receive my ID card. It also took seven and a half months to receive my Proof of Insurance, The Plan, therefore I had no idea what was covered or what the rules were.
    Every service that I have had has been questioned and only partially paid by Horizon. If I question a claim they pay even less after a review. I have been worrying and losing sleep over the bills that I have been receiving. I cannot wait until the next enrolment period so that I can switch back to my previous insurance. I would like to contact a law firm or enrol in a class action suit against Horizon.

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