On July 9, 2014, a federal court in Newark (Hon. Stanley R. Chesler) granted final approval of a class action settlement in a case brought in 2009 against Horizon Blue Cross Blue Shield of New Jersey by a policy holder, a psychologist, and the New Jersey Psychological Association, challenging Horizon’s reimbursement of out of network healthcare claims.  Horizon denied any wrongdoing and the contested the allegations in the lawsuit.

Under the terms of the agreement, Horizon will discontinue the use of the Ingenix database, except in limited circumstances, and will also discontinue the use of a Horizon database which was used to determine out of network payments.  Horizon also agreed to revise certain of its handbooks, marketing materials, and website disclosures to communicate these changes and to more clearly outline the methodology Horizon will apply to calculate the reimbursements under its plans’ out of network benefit provisions. 

The settlement covers more than 2.8 million class members.  Judge Chesler said that the class response to the settlement was overwhelmingly positive.   Judge Chesler also praised Nagel Rice's work stating that the firm handled the case in a "skilled and able" matter.

Under the agreement, Horizon agreed to pay counsel fees of $2.5 million to Bruce H. Nagel, of Nagel Rice in Roseland, who represented the class.  Horizon was represented by Phillip Sellinger and David Jay of Greenberg Traurig in Florham Park.

Click here for Law360's article on the case

Click here for New Jersey Law Journal's article on the case