Horizon pays $8M for claims handling problems

Horizon Blue Cross and Blue Shield of New Jersey has paid a $500,000 penalty and will pay nearly $8 million more to providers, patients and the state to resolve problems related to its claims handling, reports the Herald News.

The action comes after the New Jersey insurance department investigated how Horizon processed claims for Medicare customers insured through small businesses that use Horizon as a secondary insurer, according to the Associated Press.

The insurer agreed to revise how it handles claims for some members who have Medicare as their primary insurer and use Horizon as the secondary insurer. "We take seriously [the state's] findings that in certain limited instances, we have not lived up to those standards" of service to members, said Horizon spokesman Thomas Vincz.

Horizon says if it owes $50 or more on a claim, it will pay that plus 12 percent interest to the provider or patient, notes the AP. That amount is expected to total about $5.1 million. If Horizon owes $49.99 or less, it will pay that plus 12 percent interest to the state--an amount expected to total more than $1.3 million. All those payments are to be made by Oct. 1, and reported to the state by Nov. 15, notes the Herald.

In addition, Horizon paid a separate $1.4 million to New Jersey for interest on claims that had been held up as "pending" while the insurer waited to see if they could be denied because of a preexisting condition on the part of the patient.

To learn more:
- read the Associated Press article
- see the Herald News story

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