Nagel Rice Achieves Major Legal Victory in Healthcare Coverage Lawsuit
United States Federal District Court Judge Joseph Greenway ruled on December 26, 2007 that Nagel Rice client, Gregory Surgical Services, had standing to assert claims against Blue Cross/Blue Shield of New Jersey.
The Court found that healthcare providers such as Gregory Surgical Services that are reimbursed directly by an insurer for covered costs have the right to sue, under Federal ERISA law, for deficiencies in the amount of the covered payments. Horizon relied upon the anti-assignment clause in its agreement with its member/insured in order to avoid the assignment of benefits given to Gregory by its patients. The Court ruled that Horizon’s conduct in providing direct reimbursements to Gregory may constitute a waiver of a right to rely upon the anti-assignment clause. The Court allowed Gregory’s case to proceed to a trial. Nagel Rice attorneys Bruce Nagel and Robert Solomon are representing Gregory Surgical Services in this matter.