Horizon BCBS settles with MDs

New Jersey's Horizon Blue Cross Blue Shield health plan, which insures 3.2 million consumers, has settled a class action suit claiming its reimbursement practices had treated thousands of doctors unfairly. The suit, which was filed in 2002 on behalf of about 40,000 of the state's physicians, contended that the HMO--along with United Healthcare and Cigna Healthcare--was paying doctors late and reducing payments unfairly. In settling the suit, which doesn't involve a payout by the health plan, Horizon has agreed to a number of conditions, though HMO execs have not admitted any wrongdoing. These conditions include giving physicians 90-day notice of planned changes to contracts, policies and procedures; not revoking its determination of medical necessity unless it finds evidence of fraud, major errors or a dramatic change in the patient's condition prior to service; and not changing rates more than once a year.

For more about the Horizon settlement:
- read this Insurance Journal article

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