Shocked by M Horizon CEO salary? N.J. Chiropractors Association has own Horizon horror stories | Commentary | -- Your State. Your News.

Jul 05th
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Shocked by $9M Horizon CEO salary? N.J. Chiropractors Association has own Horizon horror stories


The recent revelation that Horizon Blue Cross Blue Shield of New Jersey (Horizon) CEO William Marino's compensation package last year was nearly $9 million has come as no surprise to the tens of thousands of doctors and patients throughout New Jersey who have been cheated by the healthcare giant for many years; especially to the Association of New Jersey Chiropractors (ANJC), which represents over 1,600 chiropractors statewide.

As the outcry continues from the general public, legislators, and medical practitioners across the state for legislative hearings regarding Horizon's outlandish executive compensation packages, the ANJC, whose members have experienced first-hand the intransigence and audacity exhibited by Horizon, continues to pursue several strategies to rectify various injustices visited upon chiropractors in New Jersey and their patients by Horizon.

For example, on May 25, the United States District Court for the Northern District of Illinois upheld claims filed under the Employee Retirement Income Security Act of 1974 (ERISA) against 22 leading Blue Cross Blue Shield insurers across the country, including Horizon. The action was filed by a number of individual healthcare providers on behalf of a putative nationwide class of healthcare providers, and multiple state chiropractic associations on behalf of their members, including the ANJC, the Pennsylvania Chiropractic Association, the New York Chiropractic Council, the Florida Chiropractic Association, and the California Chiropractic Association.

The lawsuit challenges the BCBS defendants' abusive practices in using post-payment audits, improper repayment demands, and automatic recoupments, to pressure providers to repay substantial sums that have previously properly been paid on behalf of BCBS subscribers. In denying a series of motions to dismiss the case, the court validated the Plaintiffs' primary legal claim that even retroactive claim denials, including those made as a result of a post-payment audit, require proper appeal rights and other procedural protections under ERISA. The Court also upheld the rights of the state chiropractic associations, including ANJC, to pursue significant policy changes in these auditing and recoupment practices on behalf of their members.

Through the lawsuit, the ANJC hopes to level the playing field for chiropractors facing repayment demands from Horizon by requiring Horizon to fulfill its existing obligations under the law. "We are not challenging Horizon's right to audit claims to ensure payments are made appropriately," said John W. Leardi, Esq., of Buttaci & Leardi, LLC, Special Counsel to ANJC, and co-lead counsel in Pennsylvania Chiropractic Association et al. vs. Blue Cross Blue Shield Association et al., Case No. 1:09-cv-05619. "But too many chiropractors in this state have been unfairly subjected to inflated or otherwise illegitimate overpayment demands from Horizon and been forced to settle because of an inherently unfair process. What we want is a process that requires transparency and fairness; a process where a doctor is given a meaningful opportunity to understand and object to an overpayment demand before facing automatic recoupments from current claims."

The ANJC also continues to fight for fair reimbursement to its members by Horizon on the "front end." For years Horizon, unlike virtually every other private insurance carrier doing business in New Jersey, refused to pay chiropractors separately for patient exams and physical therapy modalities. Instead, Horizon "bundled" reimbursement for these services into payments for chiropractic adjustments. Last October, however, the Department of Banking and Insurance (DOBI) held that Horizon's chiropractic reimbursement policies violated the New Jersey Unfair Claims Settlement Practices Act and ordered Horizon to cease and desist from "bundling" payment for patient exams and physical therapy modalities into the reimbursement it pays for chiropractic adjustments. Nevertheless, it was not until April 15, 2010, that Horizon finally began processing and paying these claims separately in compliance the DOBI's order.

Certainly the DOBI order was a tremendous victory for chiropractors in New Jersey and, more importantly, their patients. And to Horizon's credit, they appear to have stopped bundling chiropractic services on all claims, including those submitted to self-funded plans, which fell outside of the DOBI order. But they have not addressed the thousands, if not millions, of chiropractic claims that were improperly denied in violation of the Unfair Claims Settlement Practices Act prior to October 7, 2009. And frankly we owe it to our members and their patients to explore all possible avenues of potentially recovering these amounts, which we believe are substantial.

The bottom line is that chiropractors and their patients in New Jersey have been subjected to unfair treatment by Horizon for years. So the recent news that last year, when health insurance premiums increased an average of 25% and the economy nearly ground to a standstill, top Horizon executives collected over $24 million in bonuses, came as no surprise to the ANJC, its members, and chiropractic patients throughout the state.

Dr. Sigmund Miller is Executive Director of the Association of New Jersey Chiropractors.

Comments (4)
4 Thursday, 19 January 2012 18:07
Dr. John
Our politicians are shameful in allowing the insurance industry to take over control of the healthcare of the population. Denying coverage for procedures, tests, and medications is not the role people want their insurers to play. Nor do people want insurers to use up to 18-20% of premiums for administrative costs, as allowed under the Obama plan. (An increase from the current average of 15-16%). This situation is a travesty. The populace has been taken hostage and there has been no concerted effort by consumer groups, medical associations, politicians, nor large employers (who pay for coverage for their employees) to pin the insurers to the wall.
3 Friday, 18 June 2010 12:09
According to the Daily Planet (2007), several organizations demonstrated outside the annual shareholders meeting of United Health Group the largest HMO in the U.S. to "decry the gap between need and greed.” United Health Group CEO William McGuire, and his replacement Stephen Helmsley, as well as other Minnesota HMO executives, took billions in stock options. McGuire was the highest-paid CEO in Minnesota history, with stock options totaling $2 billion. Helmsley, who replaced McGuire, has stock options in excess of $750 million. In 2009 Helmsley’s compensation came to $57,000 an hour. McGuire and other executives who were ousted in October, 2006, are under criminal investigation due to stock option backdating fraud. According to Herbert Sacks past President of the American Psychiatric Association, when asked where does this money come from, he replied “from the denial and interruption of…patient care.”
Not only are CEO salaries excessive but so are their Senior VPs', VPs', and board members. For example, in 2007, the top 6 health plan boards paid themselves a whopping $277,998,793 (Jodell, 2009).
Estimates of the compensation cost for health care CEO’s and their executives total about $7 to 10 billion a year. If their pay was reduced by 80 percent it would cover health insurance for 500,000 families enrolled in a government insurance program at $10,000 per year per family. Also, if health care was nationalized the administrative savings alone would be enough to provide health care coverage for the one million uninsured in America. One third of every dollar spent on health care goes to administrative overhead and half of that goes to executives. According to the Security and Exchange Commission between 2000 and 2007 the 10 largest publicly traded health insurance corporations increased their profits 428 percent from $2.8 billion to $12.9 billion, as premiums increased 87 percent.
Health care institutions have lost the confidence of a public that once valued their altruistic mission and many maintain that executive pay is a significant part of the health care problem in America. For example, Patrick Soon-Shiong the CEO of APP Pharmaceuticals stepped down as CEO in the spring of 2008, but the former surgeon still held 83 percent of the company's shares. In July, he agreed to sell APP to a German firm. The sale finalized two months later for an initial $3.7 billion cash payment, as a result Soon-Shiong’s personal fortune gain $3 billion in 2008, (Brunwasser, 2008).
2 Tuesday, 15 June 2010 17:44
Dr Bill
Hate to tell you this, but as bad as Horizon is....and, the corruption is obvious....they are still among the best in N.J. But, BCBS making huge profits at the expense of lowering Doctor fees and raising insurance premiums by as much as 25 percent is just the tip of the iceberg. If anyone truly cares, you would surprised at the profits other companies such as Aetna, United Healthcare and Oxford have plundered over the last 12 years. Part of the problem has been the lack of concern of many NJ politicians who have curiously avoided the issues over the last decade. Wonder how many people know that the very same laws that allow certain healthcare companies to openly trade on the Stock Market can have stock secured by the very same people who are elected to public office?......there has to be some form of regulation that forbids the insurance companies to charge a co-payment that exceeds 25 % of a Dr.'s office visit. Some people may be shocked to find out that some policies from ALL NJ insurance companies essentially have policies that force the patient to pay 100 % of the office visit. This is the sort of FRAUD insurance companies impose on unknowing consumers... .In light of BCBS's CEO making a paltry sum of nearly 9 million in salary last year, I wonder if it's finally time for the insurance industry to get their deserved due and face a state congressional hearing on their curious business practices. Insurance is meant to be a third party on behalf of consumers paying the Doctor. Perhaps in the Eighties, the insurance industry cries of "greedy Dr's" were somewhat accurate. But, in the year 2010, the NJ Insurance industry has become anti-Robin Hood. Stealing from everyone to make themselves rich. Can't wait to hear how they justify this.
1 Tuesday, 15 June 2010 16:58
Shar Dreicer
Since "we" in the US are hell-bent on cleaning up corrupt corporations, it's time to clean up Horizon, BCBS. Shame on them and shame on us for allowing this travesty to take place at the expense of the chiropractors and Horizon's members.
I, who has paid BCBS high premiums will immediately consider other options. I will not give more of my money to this corrupt, unfair company.

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