$160M Settlement Approved in Class Suit over Reimbursement of Ambulatory Surgical Centers
A federal judge in Newark has granted final approval to a $160 million settlement on behalf of out-of-network ambulatory surgical centers which claimed the insurance company’s policies did not provide adequate reimbursement for services rendered.
U.S. District Judge Kevin McNulty approved the settlement terms and granted $9 million in legal fees on Friday, ending a 12-year litigation saga over claims that New Jersey’s largest health insurer shortchanged ambulatory surgical centers outside its provider network.
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The settlement terms, first filed with the court in January, were reached following mediation with former U.S. District Judge Stephen Orlofsky, who is with Blank Rome in Princeton. Most of the $160 million has already been distributed in the form of payments to the 183 ambulatory surgical centers in the class over the past decade, said Bruce Nagel of Nagel Rice in Roseland, who represented class members. Those payments are the result of revised reimbursement policies adopted by Horizon during the course of the litigation. But two subclasses of claimants, those serving small employers and those who were allegedly underpaid based on the consultant’s formula, are still awaiting additional payments of $4 million, Nagel said.
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"$160M Settlement Approved in Class Suit over Reimbursement of Ambulatory Surgical Centers," by Charles Toutant was published in New Jersey Law Journal on July 2, 2018.