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A 13-year-old class-action lawsuit accusing New Jersey's largest insurance carrier of short-changing surgery centers across the state ended Friday, resulting in a settlement of at least $160 million, federal court records and the lead attorney in the case said.

Horizon Blue Cross Blue Shield of New Jersey denies the "material factual allegations and legal claims" contained in the lawsuit, but both sides agreed to settle and avoid further protracted and expensive litigation, according to the settlement.

The settlement is an important win for the 180 same-day surgery c...

A federal whistleblower complaint alleges that a major California insurer failed to pay an estimated $89 million in taxes on premium revenue as required under the Affordable Care Act.

The complaint against Blue Shield of California focuses on the taxation of certain health plans that are funded by both an employer and insurer. It could spark more scrutiny by federal officials into whether all insurers are paying their fair share of taxes on premiums.

The ACA’s health insurance tax is one of several fees designed to help fund the health law. Employers’ self-funde...

The state has slapped sanctions on Blue Cross and Blue Shield of Illinois, saying its Medicaid managed care network of doctors and hospitals is inadequate and it isn’t responding to grievances and appeals as it should.

Blue Cross is part of the state’s recently revamped Medicaid managed care program, in which private insurers administer Medicaid benefits. Medicaid is a state and federally funded health insurance program for the poor.

According to the state, insurers in the program are supposed to provide members certain access to primary care doctors, behavioral heal...

A federal judge in Alabama overseeing a case involving 36 Blue Cross plans ruled Thursday a 1980s-era plan to divvy up service areas may violate antitrust laws, a finding attorneys said is a major blow to the companies' case.

The ruling is not final, but does provide a lens for the judge to use as the case goes to trial, said plaintiff's attorney Barry Ragsdale. The 2013 lawsuit, filed by providers and small-group subscribers, accuses the plans and the Blue Cross Blue Shield Association of violating antitrust laws that keep businesses from conspiring to affect the m...

A federal court struck a blow to Blue Cross and Blue Shield insurers in high-stakes litigation focused on how they work together, finding that some of their practices could represent an automatic violation of federal antitrust law.

U.S. District Judge R. David Proctor in Birmingham, Ala., in a late Thursday ruling, said challengers to the Blue insurers' practices had presented evidence that the Blues have adopted competitive restrictions "which, considered together, constitute a per se violation of the Sherman Act," the central federal law that bars unlawful restrai...

Since early summer, ACEP has been working hard on behalf of its members to protect the prudent layperson standard by advocating for the reversal of a dangerous new policy being enforced by the insurer Anthem BlueCross BlueShield in six states.

First implemented in July in Georgia, Kentucky, and Missouri, and most recently expanded at the start of this year to Indiana, New Hampshire, and Ohio, the policy allows Anthem to retroactively deny coverage of emergency department visits that the insurer deems as “nonemergent.” Anthem uses a list of so-called nonemergent ICD-...

TRENTON -- Gov. Chris Christie's battle with Horizon Blue Cross Blue Shield of New Jersey to give up $300 million of its reserves to the state intensified Wednesday when the governor vilified the insurer for getting slapped with $16 million in fines from the state over a period of nine months.

In a hastily called news conference, Christie accused Horizon of having "brazenly failed its members" covered by Medicaid and renewed his push for legislation he argued would add more accountability and transparency within the insurer.

The bill would also wo...

A lawsuit filed by a Los Angeles community hospital alleges Blue Cross and Blue Shield of Georgia is retaliating against the provider for being out-of-network by paying patients directly for emergency services.

Martin Luther King Jr. Community Hospital alleges in the lawsuit that the insurer is paying patients rather than the hospital as a way to pressure the hospital to accept its contract rates, or become “in-network.” The 131-bed hospital, which opened in 2015, alleges this payment system makes it difficult to get paid for providing services to the insurer's me...

As part of a civil lawsuit alleging wage discrimination, a long-time Horizon Blue Cross Blue Shield executive who left the company last year alleges the insurance giant "knowingly and systematically" underpaid claims.

Kim Dans, 50, of Farmingdale, alleges the company "turned a blind eye" to the practice because it knew few members would contest the underpayments.

Dans worked for the company for more than two decades rising through the ranks until a pay dispute and concerns about accounting problems put her at odds with her supervisor, according to the lawsuit.

Ac...

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