NEW JERSEY CHIROPRACTORS CRUSH BCBS OF NJ $33 MILLION SETTLEMENT

Chiropractors and Horizon BCBS-NJ reach a $33 million Settlement Agreement over alleged violations of the Employee Retirement Income Security Act (ERISA)

Alphonse DeMaria, et al., v. Horizon Healthcare Services, Inc., d/b/a Blue Cross Blue Shield of New Jersey, et al.. Civ. No. 11-7298 (WJM) (U.S. Dist Ct New Jersey)

On June 20, 2016 a federal District Court judge in New Jersey signed an “Order Preliminarily Approving Class Action Settlement” tentatively ending combat between chiropractic plaintiffs in a class action lawsuit brought against Horizon Healthcare Services (Blue Cross and Blue Shield of New Jersey).   The $33 million settlement is intended to terminate claims that the Horizon improperly denied benefit claims for chiropractic care and treatment in violation of the Employee Retirement Income Security Act (ERISA).  Actually, the parties reached a final settlement agreement in principle on May 6, 2015 but it took over a year to hammer out the details.

Although “preliminarily approved” the Settlement Agreement does not become effective until September 8, 2016 at which time the court has scheduled a “Final Approval Hearing” to air any objections to the settlement and to allow persons and parties to opt out of the Settlement.  At the Final Approval Hearing, the court will consider whether the settlement should be finalized and approved as fair, reasonable, and adequate for the Class.

In June 2015, the federal District Court had certified two classes in DeMaria – one an ERISA Class and a separate Non-ERISA Class.  In Plaintiffs “Memorandum of Law in Support of Plaintiffs’ Unopposed Motion for Preliminary Approval of Class Settlement, Plaintiffs noted that

“New Jersey chiropractors regularly provided Class members with three types of chiropractic treatment: (1) chiropractic manipulative therapy (“CMT”); (2) evaluation and management services (“E/M”); and (3) ancillary physical therapy (“PT”).  During the Class Period – December 16, 2005 April 10, 2010 – six years before the filing of the complaint, Horizon paid for CMT but denied all claims for E/M and PT performed on the same day as CMT on the theory that Horizon could ‘bundle’ all payments for all chiropractic treatments into a single fee for CMT.  Denial of payments for E/M and PT was automatic, and denial of all appeals was also automatic.

“In October 2009, the New Jersey Department of Banking and Insurance (“DOBI”) determined that Horizon’s bundling practice violated New Jersey’s Unfair Claim Settlement Practices Act, N.J. Stat. Ann. § 17B:30-13.1 (West). DOBI issued a cease and desist order effective April 15, 2010, requiring Horizon to cease automatically “bundling” all PT and EM claims into CMT claims without individual claims determinations, which practice Horizon ceased as of 2010.”
Following pre-litigation investigation, Plaintiff’s and their counsel stated the instant lawsuit on December 16, 2011. In addition, to Plaintiff’s state-based claims, Plaintiff’s First Amended Complaint also alleged claims under ERISA as well as State law.  Horizon moved to dismiss which was granted in part, but also denied in part.  After “extensive discovery” consisting of roughly 15,000 documents of more than 200,000 pages and claims data of more than 19 million claims records and 20 depositions, the court certified the classes as noted above.  As part of the “Class Certification Order,” the District Court ruled that “the only relief Class would be entitled to would be an order directing Horizon to re-process claims without the bundling policy, but did not indicate how such re-processing would occur.  Thus, even if Plaintiffs and the Class had prevailed at trial, there remains the likelihood of future disputes between Class members and Horizon concerning the manner in which Horizon paid or denied such re-processed claims, as well as protracted administrative appeals and litigation arising out of such disputes.”

It appears, the prospect of never-ending battles and litigation spurred the parties to settle with discussions starting in August 2014.

To read more about the case, the “Order Preliminarily Approving Class Action Settlement” and the “Memorandum of Law in Support of Plaintiff’s Unopposed Motion for Preliminary Approval of Class Settlement” are attached for review.

Gratitude Mantras

I pass these mantras on to you in hopes that you will find refuge in them.  Repeat them to yourself, and reflect on them, in those dark moments when you’ve lost track of what you have to be grateful for…

  • When life gives you every reason to be negative, think of one good reason to be positive.  There’s always something to be grateful for.
  • The greatest secret to happiness and peace is letting every life situation be what it is, instead of what you think it should be, and then making the very best of it.
  • Choose to smile today by taking life moment by moment, complaining very little, and being thankful for the little things that mean a lot.
  • No, you won’t always get what you want.  But remember this: There are lots of people who will never have what you have right now.
  • Happiness comes a lot easier when you stop complaining about your problems and you start being grateful for all the problems you don’t have.
  • Never let all the things you want make you forget about all the things you have. Today, focus on exactly what you have, not what you haven’t.
  • Be grateful for your life.  For your health, your family, your friends, and your home.  Many people don’t have these things.

How has gratitude, or the lack thereof, affected your life?

HOW TO STAY RECHARGED IN PRACTICE!

The truth is, motivation can be fleeting, which is why we need to positively recharge our mindset on a regular basis.  Does this sound like you? “I feel drained!  I’m stuck… with worry and overwhelm and frustration… and just a general lack of enthusiasm!  What should I reflect on or try to remember when I’ve completely lost my motivation?”

Here are some key things I reflect on regularly to support my practice of nurturing a more mindful, motivated mindset…

  1. It’s not the weight that breaks you down, it’s the way you carry it.  You can use pain, frustration and inconvenience to motivate you rather than annoy you.  You are in control of the way you look at life.  Beautiful things happen when you distance yourself from negative thinking.
  2. You always have a choice.  Choose to be negative and you’ll find plenty of reasons to stop and frown.  Choose to be positive and you’ll find plenty of reasons to step forward and smile.  Truly, the most powerful weapon against stress and discouragement is our ability to choose one thought over another.  Train your mind to see the good in everything.
  3. One of the most rewarding and important moments in life is the moment you finally find the courage to let go of what you can’t change. When you stop worrying and complaining about what you can’t control, you have more time to change the things you can control.  And that changes everything.
  4. It’s never in your best interests to share lots of time with people who constantly try to discourage you (even if they’re your family).  Because, if you’re the kind of person who believes there’s something out there for you beyond whatever it is you’re expected to do – if you want to be extraordinary – you can’t get there by shackling yourself to those who hold you back.  Instead, you will very likely become just as ordinary as they expect you to be.  Long-term success in life is a trifecta of ability, motivation, and attitude.  Ability is what you’re capable of doing every day.  Motivation determines what you actually do every day.  And attitude determines how well you ultimately do it.  Keep this in mind, and keep yourself in check.
  5. Sitting around worrying is a misuse of your incredible creative energy.  Instead of imagining the worst, imagine the best and how you can bring it about.
  6. It’s always better to be exhausted from meaningful work than to be tired of doing nothing.  Put in the effort and live the life you’ve imagined.  Wake up and remind yourself that you are what you do today, not what you say you’ll do someday.  Good things don’t come to those who wait – they come to those who work on meaningful goals.  When all is said and done, oftentimes more is said than done.  But it doesn’t have to be this way.  The way to get going, and feel good about it, is to quit talking and begin doing.
  7. Imagine how much more effective and happy you’d be if, instead of dreading and fighting against certain tasks, you simply got them done.  Remember, the task ahead of you is never greater than the strength within you.  Do what’s right, not what’s easy.  And when the task is a big one, do just a little bit of it every day.  Even the tiniest daily ritual changes everything in the long run.  Effort is never wasted, even when it leads to disappointing results.  For it always makes you stronger, more educated, and more experienced.  So when the going gets tough, be patient and keep going.  Just because you are struggling does NOT mean you are failing.  Every great success requires some kind of struggle to get there.
  8. The next step is always worth taking.  Seriously, no matter what happens, no matter how far you seem to be away from where you want to be, never stop believing that you will make it.  Have an unrelenting belief that things will work out, that the long road has a purpose, that the things you desire may not happen today, but they will happen.  Practice patience.  And remember that patience is not about waiting – it’s the ability to keep a good attitudewhile working hard to make progress every day, and knowing that this journey is worth it

 

THE POWER OF THE POSITIVE

The “power of positive thinking” is a popular concept, and sometimes it can feel a little cliché. But the physical and mental benefits of positive thinking have been demonstrated by multiple scientific studies. Positive thinking can give you more confidence, improve your mood, and even reduce the likelihood of developing conditions such as hypertension, depression and other stress-related disorders. All this sounds great, but what does the “power of positive thinking” really mean? 

You can define positive thinking as positive imagery, positive self-talk or general optimism, but these are all still general, ambiguous concepts. If you want to be effective in thinking and being more positive, you’ll need concrete examples to help you through the process. 

Here are seven: 

  1. Start the day with positive affirmation.

How you start the morning sets the tone for the rest of the day. Have you ever woken up late, panicked, and then felt like nothing good happened the rest of the day? This is likely because you started out the day with a negative emotion and a pessimistic view that carried into every other event you experienced. Instead of letting this dominate you, start your day with positive affirmations. Talk to yourself in the mirror, even if you feel silly, with statements like, “Today will be a good day” or “I’m going to be awesome today.” You’ll be amazed how much your day improves.

  1. Focus on the good things, however small.

Almost invariably, you’re going to encounter obstacles throughout the day—there’s no such thing as a perfect day. When you encounter such a challenge, focus on the benefits, no matter how slight or unimportant they seem. For example, if you get stuck in traffic, think about how you now have time to listen to the rest of your favorite podcast. If the store is out of the food you want to prepare, think about the thrill of trying something new. 

  1. Find humor in bad situations.

Allow yourself to experience humor in even the darkest or most trying situations. Remind yourself that this situation will probably make for a good story later and try to crack a joke about it.

  1. Turn failures into lessons.

You aren’t perfect. You’re going to make mistakes and experience failure in multiple contexts, at multiple jobs and with multiple people. Instead of focusing on how you failed, think about what you’re going to do next time—turn your failure into a lesson. Conceptualize this in concrete rules. For example, you could come up with three new rules for managing projects as a result. 

  1. Transform negative self-talk into positive self-talk.

Negative self-talk can creep up easily and is often hard to notice. You might think I’m so bad at this or I shouldn’t have tried that. But these thoughts turn into internalized feelings and might cement your conceptions of yourself. When you catch yourself doing this, stop and replace those negative messages with positive ones. For example, I’m so bad at this becomes Once I get more practice, I’ll be way better at this. I shouldn’t have tried becomes That didn’t work out as planned—maybe next time. 

  1. Focus on the present.

I’m talking about the present—not today, not this hour, only this exact moment. Focus on this one, individual moment. In most situations, you’ll find it’s not as bad as you imagine it to be. Most sources of negativity stem from a memory of a recent event or the exaggerated imagination of a potential future event. Stay in the present moment. 

  1. Find positive friends, mentors and co-workers.

When you surround yourself with positive people, you’ll hear positive outlooks, positive stories and positive affirmations. Their positive words will sink in and affect your own line of thinking, which then affects your words and similarly contributes to the group. Finding positive people to fill up your life can be difficult, but you need to eliminate the negativity in your life before it consumes you. Do what you can to improve the positivity of others, and let their positivity affect you the same way. 

Almost anybody in any situation can apply these lessons to their own lives and increase their positive attitude. As you might imagine, positive thinking offers compounding returns, so the more often you practice it, the greater benefits you’ll realize.