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Class Action Settlement Reached in Flawed Health Plan Reimbursements

By Greg Kohn

November 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 the 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 supporting 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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The attorneys at Nagel Rice, LLP represent clients throughout New York and New Jersey in a wide range of matters including personal injury, automobile accidents, brain injuries, medical malpractice, business litigation and class action cases.

About the Author
Greg Kohn is a partner at Nagel Rice and specializes in complex civil litigation cases, including professional malpractice, personal injury, class actions, wrongful death, products liability, and commercial litigation.  He has extensive experience representing clients in both state and federal court. Greg has tried many jury trials to verdict and has recovered over $50 million in settlements and verdicts in all types of personal injury matters including automobile accidents, wrongful death cases, slip and falls, and other catastrophic injury cases. Greg also handles medical malpractice cases, involving misdiagnoses, wrongful birth, and delayed cancer diagnosis. If you have questions regarding this article, you can contact Greg here.
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