Health Insurer Horizon Settles with NJ for $100M Stemming from Health Care Overpayment Allegations
- outreach0686
- Dec 30, 2025
- 2 min read
Dear CCC Health Community,
I wanted to share an example of why patients and physicians are pushing so hard for transparency and honesty in healthcare.
New Jersey recently reached a $100 million settlement with Horizon Blue Cross Blue Shield after the state alleged the insurer overcharged taxpayers for healthcare services. The issue centered around a simple rule in their contract: Horizon was supposed to bill the state whichever amount was lower, either the price a doctor or hospital actually charged, or the previously negotiated insurance rate.
The state says that instead of using the lower price, Horizon often charged the higher one. In one case, a hospital billed roughly $675,000, but over $2 million was charged and paid. The state viewed this as the insurer not following the agreed-upon cost-saving rules. Horizon denies wrongdoing and says the disagreement was simply about how the contract language was interpreted.
Even so, Horizon will pay $100 million. Most of that money goes back into the health plans that cover New Jersey’s public employees, teachers, and retirees.
Several important points:
No one accused hospitals or doctors of wrongdoing, this was specifically about how the insurer billed the state.
Patients did not do anything wrong, and this does not affect individual citizens’ insurance claims or benefits.
The case highlights how complex the insurance system is and how easily costs can rise without patients or physicians even knowing why.
As we talk about reforming healthcare and building trust, stories like this remind us why patients feel frustrated and why physicians are working so hard to build models like Direct Primary Care that are transparent, honest, and focused on caring for people rather than navigating a maze of billing rules.
It's another example of how the system we inherited isn’t broken because of patients or physicians. It’s broken because it has become too complicated, too opaque, and too far removed from real care. I share this not to create fear, but to offer hope:
We can build a better system. One rooted in clarity, trust, and accountability where every dollar patients spend goes directly toward their health, not toward unnecessary administrative waste.
Source;
“Health insurer Horizon settles with New Jersey for $100 M stemming from health care overpayment allegations.” Politico, Nov 14 2025.
Comments