Claims Involving Reimbursements By Insurance Companies

Health insurance companies have come under fire in recent years by consumers and medical providers alike for misconduct surrounding health-related reimbursements. Nagel Rice, LLP, remains on the forefront of these cases, and provides experienced representation in managed care class actions in New Jersey and nationwide.

Nagel Rice obtained a $200 Million class action settlement with Horizon Blue Cross Blue Shield, involving reimbursements to out-of-network surgery centers in New Jersey, one of the largest class action judgments in the state. Click here to review more class action verdicts and settlements.

Experienced Attorneys For Health Insurance Reimbursement Claims

Our firm handles class action lawsuits involving insurance reimbursements brought on behalf of both medical providers as well as patients. Typically, such cases arise over disputes regarding the reimbursement, or lack thereof, provided by Horizon Blue Cross Blue Shield, United Healthcare, AmeriHealth Insurance, Aetna and other major insurance corporations for services rendered at facilities that are considered “out-of-network.”

By law, insurance companies must reimburse out-of-network health care providers at a percentage of the usual, customary and reasonable (UCR) rates health care facilities charge, dependent upon the patient’s benefits. However, how insurance companies calculate UCR rates is not always transparent, leading to alleged rate manipulation and underpayment.

Health Insurance Reimbursement Claims Involving Individual Patients

Patients themselves can also experience the effects of UCR rate manipulation by health maintenance organizations (HMO) or preferred provider organizations (PPO). Many patients pay higher premiums in order to obtain out-of-network care. When patients take advantage of this benefit, however, they may find themselves responsible for additional out-of-pocket expenses or have valid HMO or PPO claims unfairly denied based on an inaccurate rate of reimbursement.

Nagel Rice has the resources and experience to litigate such claims involving reimbursements from insurance companies. If you believe your claim may be appropriate for class action representation, contact Nagel Rice at 973-618-0400 to discuss your case in more detail with a knowledgeable class action lawyer.