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Sunday, May 19, 2024


Nanavati vs. Horizon, Round Two: Doc Claims Insurer Stalled Reinstatement


By Joe Hart

COURT HOUSE — Are health insurance companies above the law?
A local cardiologist who recently won a lawsuit against one of them seems to think so.
“Insurance companies have been given immunity by the courts,” Dr. Suketu Nanavati, of the Cape Heart Clinic told the Herald. “They’re more powerful than the President of the United States.”
Whether that’s true or not, Nanavati prevailed over Horizon Blue Cross Blue Shield – New Jersey’s largest health insurer – nine months ago after a decade-long battle with the company to remain on its participating physician list.
Despite being ordered by the courts to “immediately” reinstate Nanavati, the insurance giant dragged its feet and failed to notify the doctor when his status had changed, Nanavati said.
The problem started in May 1996 when Nanavati was dropped from Horizon’s roster of doctors due to an investigation by the state Board of Medical Examiners relating to a suicide death of one of his patients.
In June of that year, Nanavati’s attorneys were able to obtain a restraining order imposed on Horizon keeping them from removing him from its panel or informing patients of their intention to remove him pending the outcome of the board investigation.
The investigation was concluded in 1998 with a reprimand for Nanavati who had to pay a $5,500 fine, but did not have his medical license suspended or revoked.
In 2000, Nanavati was again dropped by Horizon relating to the same incident and the cardiologist has been battling in court to be reinstated since then.
Thomas Harty, a Cherry Hill attorney who represented the cardiologist, was recently able to persuade Superior Court Judge Joseph Visalli that Nanavati was released by Horizon without sufficient cause.
He said Horizon had an agreement with Nanavati after the first incident in 1997 that stated the company would not pursue any further discipline if the state allowed him to keep his license. He said the insurance giant broke that agreement by releasing Nanavati again.
Visalli, who is now retired, found in the doctor’s favor on Sept. 14 last year. He said Horizon had broken its contract with Nanivati and ordered the insurance company to reinstate the cardiologist.
The order stated that Nanavati “shall be immediately reinstated as a Participating Physician by Horizon Blue Cross Blue Shield…effective as of the entry of this judgment.”
The Herald reported the decision in October 2007 and the case has since received some notoriety.
Nanavati’s case was featured in the April 2008 Credentialing & Peer Review Legal Insider, a newsletter published by HCPro Inc., which is a leading provider of integrated information, education, training, and consulting products and services in the areas of healthcare regulation and compliance.
When Nanavati was still waiting to be reinstated in May of this year, Harty corresponded with Horizon threatening a contempt of court motion if the company did not reinstate the doctor to its ranks.
Soon after that, Nanavati learned that as of Feb. 22 this year he had been reinstated as a participating physician, but he was never informed of the action by Horizon, he said.
“They never wrote or called me regarding my change of status despite weekly calls from my office for updates on their compliance with the judge’s order,” he told the Herald. “Who do they think they are? First they delay, then they don’t even tell me I’ve been reinstated.”
When asked if he received an apology from the insurance company, Nanavati laughed.
He said he intends to sue for damages for the patients he had to turn away in the past eight years when he’s only been able to treat those on Medicare or those wealthy enough to pay out of their own pockets.
Nanavati said it’s not only a financial issue, but also a quality of care issue.
Horizon has a 16 percent mortality rate for heart failure and 11 percent for heart attack, Nanavati said, while his is 0 percent for both conditions.
There have been people who died because he wasn’t able to treat them due to this insurance issue, the cardiologist said.
“If Horizon thinks I’m finished with them after they’ve treated me in this way for over 10 years, they must not know me very well,” Nanavati said. “I’ll continue to fight until justice is done.”
Contact Hart at (609) 886-8600 Ext 35 or at:

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