November 14, 2012:
Joshua N. Garick, Esq. obtained a judgment against Blue Cross and Blue Shield of Massachusetts, Inc. after a two day trial at the Quincy District Court. Mr. Garick filed claims under the Massachusetts Consumer Protection Act (G. L. c. 93A) and Unfair and Deceptive Insurance Claims Prevention Act (G. L. c. 176D) because Blue Cross/Blue Shield failed to pay a dental claim for orthodontic services within 30 days as required by the Subscriber Certificate (i.e., the contract between the customer and Blue Cross).
Not all dental plans have orthodontic coverage. However, under a Dental Blue policy, where orthodontic coverage is included, all orthodontic claims must be paid within 30 days. Blue Cross Blue Shield, however, is splitting the claim into two installments and making the second payment 6 months after the claim is filed. The Law Offices of Joshua N. Garick, P.C. believes this is a prevalent problem where Blue Cross is disregarding its obligations under the Subscriber Certificate to the detriment of its insured customers. If you believe your health insurance or dental insurance company is not paying claims properly, whether you are insured by Blue Cross or by another insurer, please contact us for a no obligation consultation. We would be happy to explore whether you have any individual claims or claims that can be brought on behalf of a class of others who have been similarly harmed.