San Jose Neurospine v. Blue Shield of California

Analysis Group assisted Blue Shield of California in a suit alleging that Blue Shield’s payments for three out-of-network neurosurgery claims were below the provider’s usual, reasonable, and customary charges. An Analysis Group team led by Managing Principal Mark Gustafson and Vice President Phil Hall-Partyka supported Managing Principal Bruce Deal, who provided deposition and trial testimony on behalf of Blue Shield on the reasonable value of the services provided and explained how full billed charges is not a measure of reasonable value. The jury found that Blue Shield’s original reimbursement was, in fact, in excess of the reasonable market value of the services.