Could l forward this to another list? Jon Slater Comox, B.C. http://www.usefilm.com/photographer/20412.html -----Original Message----- From: [mailto:] On Behalf Of Lynn Cramer Sent: Monday, August 02, 2004 2:58 PM To: Cc: ; Subject: Re: Horizon BCBS Lawsuit It is heartening to see pediatricians taking a stand and refusing to let another industry decide what our services are worth. The surgical specialties have valued themselves more for years and have the reimbursements that show it. We tell our children that people know and respect you when you respect yourself. New Jersey pediatricians are to be applauded. First Aetna now the Blues. Kudos to them! and in our own small way, for the same reasons the suit is being pursued. our practice is dropping Blue Shield in sixty days! effective 10/01/04 we decided to say stop, you will not be jerking this practice around any longer Lynn Cramer RNC Practice Administrator Eden Park Pediatrics Lancaster, PA On Mon, 2 Aug 2004, Chip Hart wrote: > > Received this last week. Anyone wish to comment? > > > PRESS ADVISORY > > > For Immediate Release July 29, 2004 > Livingston, New Jersey > > On July 27, 2004, the Essex County (New Jersey) Superior Court > certified a major class action filed by Clifton pediatrician, John I. > Sutter, M.D., on behalf of over 40,000 physician providers in New > Jersey seeking tens of millions of dollars for improper claims > processing practices committed since 1996 by Horizon Blue Cross Blue > Shield of New Jersey ("Horizon"), the largest managed care organization > and HMO in the state. > > In all, the Court certified three classes of physicians seeking redress > from several different claims processing abuses committed by Horizon. > The largest class numbers over 40,000 and seeks monetary damages for > Horizon's consistent failure to pay claims timely as well as the > insurer's failure to pay appropriate interest on late paid claims in > violation of the New Jersey prompt payment statutes (the "Prompt Pay > Claim Class"). In reaching its holding, the Court took note of the > "unrebutted" New Jersey Department of Banking and Insurance Market > Conduct Report which had examined Horizon's claims processing during > 2000-2001 only and yet, observed the Court, found "fairly extensive > prompt pay violations" over that time period. > > The Court also certified a class of almost 2,000 pediatricians damaged > by Horizon's intentional computerized alteration and manipulation of > bills submitted by the class which was done to pay less to these > doctors and significantly increase the "bottom line" of Horizon (the > "Contract Claim Class"). > > Finally, the Court certified a class of approximately 3,000 physicians > who have been damaged by the insurer's failure to pay the appropriate > compensation to those physicians who are entitled to monthly payments > based on the number of patients who have selected the physician as > their primary care provider (the "Capitation Claim Class"). > > The Court also held that the plaintiffs may apply for injunctive relief > on behalf of all physician specialties to prevent Horizon from > unlawfully processing claims in the future. The Court also left open > the opportunity for the plaintiffs to add additional lead class > representatives for other physician specialties (other than > pediatrics), as part of the Contract Claim Class, who have been > similarly affected by Horizon's improper automated claims processing, > thereby increasing the overall amount of monetary damages that can be > sought by the class. > > According to lead plaintiffs' class counsel, Eric D. Katz, a partner > at the Livingston, New Jersey law firm of Nagel Rice & Mazie, "the > Court's ruling is very significant to the over 40,000 doctors in this > state that have been subjected to Horizon's claims processing abuses > for many years. Physicians in New Jersey have little choice but to > participate with Horizon in order to have access to its vast patient > base numbering over 3 million. Until now, however, these doctors have > had to helplessly take it on the chin from the insurer because they > have had no legitimate recourse to challenge the manner in which > Horizon does business. But all of that has changed now with this > ruling and we look forward to immediately adding additional physician > specialties as class representatives and moving this case along > swiftly to conclusion and obtaining the best possible relief for our > state's physicians." > > In April 2002, Dr. Sutter filed his class action lawsuit against > Horizon. The suit was filed to address the ever-widening healthcare > crisis brought on by the continuing abusive practices of Horizon. The > healthcare providers seek damages against the HMO for its repeated > improper claims processing practices designed to delay and reduce > reimbursement to the healthcare providers for the medical services they > provide. Dr. Sutter alleges that the significant claims processing > abuses by Horizon continue on a daily basis and have jeopardized the > ability of New Jersey healthcare providers to offer quality medical > care to the people of the State of New Jersey. The costs associated > with the delivery of such care are substantial and include payment of > overhead and salaries for nurses and para-medical professionals and > payment for the purchase of supplies, equipment and medicines. These > costs can only be met if Horizon makes prompt and appropriate payment > of claims to the healthcare providers. > > > For further information and for interviews, please contact lead > plaintiffs' class counsel: Eric D. Katz, Esq., Nagel Rice & Mazie, 301 > South Livingston Avenue, Suite 201, Livingston, New Jersey 07039, Tel. > No. 973-535-3100 x122; Fax No. 973-535-3373, and e-mail > . > >