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A politically charged lawsuit that originally would have pitted seven independent New Jersey hospitals against the state’s largest health insurance company has ended. Less than two hours before oral arguments were to begin in a Hackensack courtroom, The Valley Hospital, the last remaining plaintiff in the case, agreed to withdraw its claim that Horizon Blue Cross Blue Shield of New Jersey’s OMNIA health plans violated the spirit of its contract with the hospital. Horizon said in a statement it was “pleased to have reached an agreement with Valley Health System. We...

CentraState Medical Center in Freehold Thursday became the latest hospital to drop a three-year-old lawsuit against Horizon Blue Cross Blue Shield of New Jersey that accused the state's dominant health insurance provider of squeezing community hospitals out of the market.

CentraState was once one of seven hospitals that sued Horizon for relegating them to a more expensive tier in the company's OMNIA discount health plans, which Horizon said would revolutionize health care options in the state.

Valley Hospital in Ridgewood, the last plaintiff in the case, an...

The American College of Emergency Physicians (ACEP) and the Medical Association of Georgia (MAG) today filed suit against Anthem's Blue Cross Blue Shield of Georgia in federal court in an effort to compel the insurance giant to rescind its controversial and dangerous emergency care policy that retroactively denies coverage for emergency patients. To read the lawsuit, click here.

Over the past year, Anthem implemented its policy in Georgia and five other states, leaving patients who sought emergency care responsible for paying their entire bills if the insurance comp...

A controversial policy instituted by Blue Cross Blue Shield of Georgia and parent company Anthem Insurance Cos. denying emergency room claims after the fact faces a legal challenge by two physicians organizations.

The American College of Emergency Physicians and the Medical Association of Georgia have asked a federal judge in Atlanta to compel Blue Cross Blue Shield and Anthem to abandon the policy, which the insurers have also implemented in Missouri, Kentucky, Indiana, New Hampshire and Ohio.

The policy, which the insurers announced last year, allows the companies...

Cliffside Park, N.J.-based Surgery Center of Cliffside alleges Horizon Blue Cross Blue Shield of New Jersey underpaid the center for a lesion procedure by $58,120.40, court documents show.

Here's what you should know:

1. Surgery Center of Cliffside filed a lawsuit against Horizon Blue Cross Blue Shield of New Jersey and Empire Blue Cross Blue Shield July 3. Empire is a licensee of BCBS.

2. The ASC performed surgery on a patient insured by Empire who had a painful, rapidly growing lesion on the side of her face.

3. In January, prior to the procedure, an Empire represent...

CMS will not make $10.4 billion in payments that were due to insurers under the ACA. 

Here's what you should know:

1. The payments were required under the ACA's "risk adjustment program" to offset costs for insurers whose customers need expensive medical services. They were due to insurers in the fall for expenses from 2017.

2. CMS Administrator Seema Verma said the suspension is based on a legal dispute over the formula used to calculate risk adjustment payments. About three years ago, a New Mexico federal court ruled the formula was flawed, but a Massachusetts judge...

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...

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