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Horizon 'knowingly' underpaid patient claims, former exec charges in lawsuit

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.

According to the lawsuit, Dans she witnessed several violations of state regulations, including:

  • The company refused to correct a computer programming error that led to the chronic underpayment of claims.

  • The company routinely denied two types of patient claims - those for emergency care and those involving a pre-existing condition - on the premise that only a fraction of customers would fight the denial.

  • The company was alerted about upcoming state audits.

The Newark-based insurer of 3.8 million New Jerseyans vigorously denied the accusations.

"Horizon is the largest, most scrutinized and most regulated health insurer in New Jersey with a national reputation for excellence," a spokesman said. "Unfortunately, we are sometimes sued by individuals who make dramatic accusations hoping to extract a settlement. The unsubstantiated allegations made here simply have no merit."

The lawsuit, filed in Superior Court in Essex County last month, details a career at Horizon that began in 1987. She proceeded up the corporate ladder until she was promoted to Senior Director of the Service Division, according to the lawsuit.


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