Court Orders Medical Group to Rescind Bills to Patients

Vanguard Anesthesia Associates is going to be pretty busy for the next few months.

Thanks to a court order, the company has to stop billing Horizon Blue Cross/Blue Shield members.  New Jersey Judge Catherine Langlois also ruled that Vanguard has to call off any collection agencies pursuing payment on its behalf, take steps to make sure patients’ credit ratings are not affected, and reimburse Horizon members for money they already paid to the anesthesia company. Aaaaand, Langloids 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.

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

So, what’s going on?  It turns out that folks in New Jersey – some 2,000 folks, specifically – were being billed for anesthesia that should have been covered by Horizon Blue Cross/Blue Shield.  Instead, 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.

This means that there are more court cases in Vanguard’s future, as Horizon Blue Cross/Blue Shield adds itself to the list of entities suing the anesthesia company.