Horizon Blue Cross LawsuitHorizon Blue Cross Blue Shield of New Jersey Inc. has agreed to settle a class action lawsuit that alleges the insurer inadequately reimbursed subscribers for out-of-network services.

Under the terms of the proposed Horizon Blue Cross class action settlement, Horizon will stop using the Ingenix database for the calculation of out-of-network (ONET) claims for covered services for the bulk of Horizon plans. The insurer also agreed to revise the language for all plans sold or renewed by Horizon to more accurately reflect the way reimbursement rates are calculated for ONET claims. Horizon will also update its member handbooks, marketing materials, member portal and website with similar information.

Plaintiff Cathleen McDonough initially filed the Horizon Blue Cross class action lawsuit against Horizon in 2009, claiming that the insurer systematically under-reimbursed Horizon subscribers because the insurer relied on the flawed Ingenix database or a flawed reimbursement schedule to calculate benefits. She accused the company of violating the Employee Retirement Income Security Act (ERISA) by making ONET determinations based on “unauthorized and undisclosed rules.”

Psychologist Barry Helfmann and the New Jersey Psychological Association filed a similar class action lawsuit, alleging that psychologists were systematically under-reimbursed by Horizon for their services. Because the two actions were consolidated, the class action settlement would resolve both disputes if approved.

The parties seek preliminary certification of two sub-classes for class action settlement purposes. The first is a sub-class comprised of all persons enrolled in a Horizon health plan since Feb. 9, 2003, that includes an ONET benefit. The second is a subclass of all ONET health care providers who are not licensed medical doctors or doctors of osteopathy who provided Horizon subscribers with covered services since Feb. 9, 2003, but were paid less than their billed amount for these services.

According to a brief submitted by the plaintiffs, the class action settlement will affect millions of Horizon insurance plan members and out-of-network providers by granting proposed Class Members “significant declaratory and injunctive relief in the form of business reforms as well as the payment of fees and class representative payments.”

Horizon agreed to pay McDonough $20,000 and the New Jersey Psychological Association $15,000 under the terms of the proposed class action settlement agreement. Horizon also agreed to begin phasing out the Ingenix database 60 days after the judge approves the proposed class action settlement.

Notice to potential Class Members will be sent via U.S. mail and will be published in the Newark Star Ledger, The Courier Post, the Asbury Park Press and USA Today. A class action settlement website will also be established. Keep checking www.TopClassActions.com or sign up for our free weekly e-newsletter below for claim filing instructions.

The plaintiffs are represented by Bruce H. Nagel and Randee Matloff of Nagel Rice LLP.

The Blue Cross Out-of-Network Reimbursement class action lawsuit is McDonough, et al. v. Horizon Blue Cross Blue Shield of New Jersey Inc., Case No. 2:09-cv-00571, in the U.S. District Court for the District of New Jersey.

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Please note: Top Class Actions is not a settlement administrator or law firm. Top Class Actions is a legal news source that reports on class action lawsuits, class action settlements, drug injury lawsuits and product liability lawsuits. Top Class Actions does not process claims and we cannot advise you on the status of any class action settlement claim. You must contact the settlement administrator or your attorney for any updates regarding your claim status, claim form or questions about when payments are expected to be mailed out.

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18 Comments

    • Barbara Vadasz January 21, 2014

      I really don’t know what’s going on.

  • Deborah January 27, 2014

    What do we do? Never been involved in something like this before.

  • Ray January 29, 2014

    I had $2000 out of pocket cost. Not sure if I am untitled to any part of settlement.

    • Ray January 29, 2014

      Sorry typo. Intitled to settlement.

      • Got a letter February 16, 2014

        I may be reading this wrong, but I don’t see anything where anyone else gets any reimbursements…. Only the lawyers (who get the lions share), McDonough, and the New Jersey Psychological Association. I’m probably going to opt out of this, and especially if you think they overcharged you too, I think you should opt out too. If you don’t, you give up any rights to sue for what they overcharged you in the future.

        • Lynda February 17, 2014

          What’s going on? I need a phone # to speak to someone !

  • Debbie Sochanchak March 3, 2014

    I would like to participate in the class action suit. The paperwork I received states I must file by March 3rd, 2014. That is today. I understand the final settlement hearing will be April 1, 2014. Is this request within a timely fashion?

  • altonio reed March 20, 2014

    I wanted to know what was going on with the case. Every time I try to reach someone is through the automated system. Do I need to be in court with the lawyers if so please contact me.

  • Jay April 5, 2014

    I don’t think subscribers are getting anything, just lawyers & the other 2 plaintiffs, there just updating the system. I may be wrong, but it doesn’t say anything about subscribers getting payments?? Not sure & no one to call as usual!

  • Emmanuel A. Boani April 9, 2014

    I want to know what was the final agreement on April 1, 2014 during the court hearing on the class law suit settltment in Newark, New Jersey. And I also want to know how and when am I going to get my share of the settlement.

    • Greg Trepin April 15, 2014

      I would also like that info

  • Jay April 17, 2014

    It is extended to opt out until June!

  • mercuria lucombe June 4, 2014

    Wanted to know the status on any on what’s going on with the settlement..thank you!!

  • S Collins June 20, 2014

    I sent an e-mail to the contact on the website and I have not heard anything.

  • CINDY July 1, 2014

    I CALLED/EMAILED THEM ON 6/26/14-AFTER THE COURT HEARING?? NOW IT IS 7/1/14=NO REPLY AND NOTHING NEW ON THERE WEBSITE!

  • alice schlesselman August 12, 2014

    does anyone know the status of whats going on??

  • Kathy Cohen September 9, 2014

    Has anyone heard anything yet? It’s been 3 months, I’m not sure how long this Will take.

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