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SOURCE Office and Professional Employees International Union, AFL-CIO (OPEIU)
Court reverses reduction of out-of-network reimbursement rate
WAYNE, N.J., Sept. 5, 2013 /PRNewswire-USNewswire/ -- The New Jersey Society for Clinical Social Work (CSW)/OPEIU Guild 49 has won its legal action against the State Employees Health Benefits Plan (Horizon BCBS) for lowering their rate of reimbursement to out-of-network practitioners in January 2009.
The NJ State Appellate Division has decided that the lowering reimbursement rates by the SHBP and Horizon was done in violation of N.J.S.A.52:14-17.46.7.
"This means that Horizon BCBS must reverse the reduction in reimbursement rates to LCSW's back to levels before 2009," said Luba Shagawat, MSW, LCSW, S-NAP, the director of legislative affairs for Guild 49. "It's taken a long time to get this victory, but we are thrilled that the courts have reversed this injustice and returned the rate to a fair level. It proves the power of a collective voice, and what can be accomplished when workers unite for a common purpose."
The court found that the statute at issue "does not authorize the Commission (Horizon) to deviate in any way, including rejecting the PHCS UCR fee schedule, relying on non-nationally recognized database of prevailing health care charges to change that fee schedule, and imposing a percentage rate or condition the statute does not permit. Thus the Commission's decision was arbitrary, capricious and unreasonable and must be reversed."
The Office and Professional Employees International Union (OPEIU), AFL-CIO represents more than 105,000 members in the United States, Puerto Rico and Canada. OPEIU represents employees and independent contractors in banking and credit unions, insurance, higher education, shipping, hospitals, medical clinics, utilities, transportation, hotels, administrative offices and more.
Professional organizations and Guilds affiliated with OPEIU are a diverse group that includes nurses, pharmacists, chiropractors, appraisers, podiatrists, clinical social workers, minor league baseball umpires, teachers and helicopter pilots.
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