Noveember 15, 2013 - Bruce Nagel and Nagel Rice reached a settlement with Horizon Blue Cross Blue Shield of New Jersey Inc. that accused the insurer of under-reimbursing health plan subscribers for out-of-network services. As part of the settlement, Horizon has agreed to stop using a database that produced allegedly flawed calculations.
Horizon will stop using the Ingenix database to calculate claims for covered services provided by out-of-network providers. The company will also discontinue use of its “Top of Range” reimbursement schedule for such claims, which plaintiffs' attorney Bruce Nagel said was “statistically flawed.”
“The settlement will affect millions of Horizon plan members and their ONET providers,” the plaintiffs said in a support brief filed with the settlement. “The joint application ... grants the class significant declarative and injunctive relief in the form of business reforms as well as fees and class representative payments.”
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