Insurer Agrees to Pay N.J. ASCs $22M to Settle Class-Action Suit

ASCs accused Horizon Blue Cross Blue Shield of failing to pay out-of-network claims.

Horizon Blue Cross Blue Shield of New Jersey has agreed to pay about $22 million to settle a class-action lawsuit brought by a group of ambulatory surgery centers over out-of-network reimbursements.

In the suit, the New Jersey ASCs had accused the insurer of failing to properly reimburse them for out-of-network services provided to Horizon subscribers. According to a joint statement, the 2 parties agreed to settle "to avoid the risk and expense of lengthy protracted litigation." The settlement still has to be approved by the U.S. District Court in Newark, N.J.; the parties say they expect the court to render a final decision by the end of the year.

According to the settlement terms, preliminarily approved by Judge Madeline Cox of the District Court of New Jersey this week, the ASCs involved in the suit will be entitled to:

a percentage of Horizon's $22 million cash settlement;
"retroactive adjustment of claims for services rendered in 2009";
increased reimbursements for services rendered from 2011 through 2013; and
"several business reforms that provide significant value to the surgery centers."

According to the joint statement, the proposed settlement covers "approximately 130 ambulatory surgery centers in New Jersey."

Irene Tsikitas