Court orders medical group to rescind bills to patients
Horizon lawsuit claims anesthesia provider was overcharging individuals
Wednesday, January 17, 2007
BY JOE MALINCONICO
Star-Ledger Staff

Colleen Simmers didn't know what to do.

Back when she had surgery in November 2004, the Cherry Hill woman had made sure all her medical providers were covered by her Horizon Blue Cross/Blue Shield insurance network.
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But two years later, she received a bill from Vanguard Anesthesia Associates saying she owed $689. A month after that, she got a notice from a collection agency.

"I really felt like I was getting robbed by an anesthesia company and that I had no place to turn," Simmers said.

She was among people who filed more than 2,000 complaints with Horizon about Vanguard's billing over the past five months, prompting the insurance company to take legal action. Last week, a Superior Court judge in Morris County ordered Vanguard to stop billing Horizon members for payments in addition to their insurance coverage.

The judge, Catherine Langlois, also ruled that Vanguard has to call off the collection agencies, take steps to make sure patients' credit ratings are not affected and reimburse Horizon members for money they already paid to the anesthesia company. She also ordered Vanguard to provide within 30 days a full report of all patients who had been billed to ensure the anesthesia company complies with her decision.

That ruling came from a preliminary hearing in the case. Horizon's lawsuit against Vanguard is still pending. A date for trial has not been set, said Emmer.

"The court order is a total vic tory for Horizon Blue Cross Blue Shield of New Jersey members," said Horizon spokesman Dan Emmer. "In granting a preliminary injunction, the court has determined that there is 'likelihood of success on the merits of our case.'"

Kimberly Hynes, the attorney handling the case for Vanguard, did not return phone calls seeking comment on the case.

Vanguard is no longer providing anesthesia in New Jersey. It had been providing services in South Jersey. Its parent company is based in Boca Raton, Fla.

In court papers, Vanguard has contended that the company itself never had a contract with Horizon, although it acknowledges that 44 of its 85 physicians were part of Hori zon's network of providers.

The anesthesia company says that it is entitled to collect payments from patients to cover the difference between what Horizon had paid and what Vanguard considers its full fees. The company's president, Richard Krugman, said in court papers that Vanguard is owed $4.3 million for bills from between Jan. 1, 2004 and April 30, 2006.

Among the people getting col lection notices for those bills is Mark Doran. In recent weeks, Doran said he had not been able to contact Vanguard directly because no one picks up the phone at the number provided on its initial bill. Meanwhile, he said, Horizon has advised him not to pay the Vanguard bill, while the collection agency urged him to send in the money.

"I laughed and said that anyone who pays one cent of a situation still under litigation is a fool," he said.

Still, Doran is worried this might affect his credit rating.

"I'm keeping my fingers crossed on this one," he said.

Joe Malinconico may be reached at jmalinconico@sarledger.com or at (973) 392-4230.