A class action settlement, valued as much as $50 million, between New Jersey physicians and Horizon Blue Cross Blue Shield of New Jersey was approved by the Superior Court of New Jersey on June 16th.  The settlement removes the "black box" in which Horizon has been processing claims submitted by physicians.  Under the settlement terms, among several other benefits, Horizon must dislcose to physicians all fee schedule information and provide an interactive web tool that allows physicians to input procedure codes before services are rendered in order to learn how Horizon will process and pay those codes.  In addition, a dedicated liaision was established to assist capitated physicians to enable them to be paid properly and quickly for the services they render.  Our law firm represented the Class in this action.  The Court's complete opinion is attached to this post.

Sutter Opinion.doc (77.50 kb)

United States Senator Frank Lautenberg has asked the IRS to examine the compensation package for Horizon Blue Cross Blue Shield's CEO William Marino.  Incredibly, while physicians are repeatedly pinched for every penny they earn from treating Horizon members, Marino recently walked off with salary and bonuses totaling $8.7 million last year -- from a company that is not-for-profit.  Senator Lautenberg said he is contemplating legislation to rein in the pay of Blue Cross executives.  We laud Senator Lautenberg's actions.