Denied Insurance

Pittsburgh, PA: (Nov-28-07) A class action lawsuit was brought against insurance giant Highmark Inc. and its affiliated companies, Keystone Health Plan West, Highmark West Virginia Inc, doing business as Mountain State Blue Cross Blue Shield, and Parker Benefits Inc., doing business as Super Blue HMO, by physicians and other plaintiffs, alleging that during a period of 8 1/2 years beginning in May 1999, Highmark and other insurers fraudulently denied claims. The case, filed in federal court in Florida, stated that the defendants engaged in a conspiracy to improperly deny, delay or reduce payment to physicians, physician groups and physician organizations by engaging in several types of allegedly improperly conduct. The suit also claimed that the defendants violated a federal statute known as the Racketeer Influenced and Corrupt Organizations Act, known as RICO.

As part of a tentative settlement reached, primarily to avoid the costs and risks of protracted litigation, the defendants agreed to pay close to $14 million to resolve the case. [PITTSBURGH TRIBUNE REVIEW: DENIED INSURANCE]

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