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The quality, cost and convenience of health care are all shaped by the extensive set of laws that govern almost every aspect of the health care system. As a not-for-profit company, Horizon exists for the benefit of our members – not for investors or stockholders or interests other than what is best for our members.

Here are five ways that Horizon has worked with lawmakers and state officials to make health care more responsive to you:

Modernizing the way Horizon is structured so we can better anticipate and meet the evolving needs of our 3.7 million members.

Eliminating egregious surprise medical bills from treatment providers who do not participate in insurance networks. Out-of-network reform helps protect Horizon members from “surprise” medical bills.

Working to strengthen New Jersey’s marketplace and make health insurance more affordable for the individuals and small businesses that buy their insurance on the State’s Health Insurance Exchange.

Working closely with state agencies, including the Long-Term Care Ombudsman and Department of Human Services, to help make health care better, especially for people who rely on Medicaid for their health insurance or who have special needs.

Working to protect against health care fraud.

Health care fraud costs our health care system and everyone who pays a premium between $74 billion to $264 billion across the United States. Fraudulent billing by providers, identity theft and cyber-attacks by hackers are just a few examples of the ways bad actors are abusing the system and driving up costs.

Horizon employs a full-time team of investigators and analysts who spend their days rooting out fraud. They team with state and federal law enforcement to press criminal charges and work with Horizon’s in-house attorneys to file civil actions to protect the premiums our members entrust to us. Here are three ways Horizon is fighting fraud:

• Through litigation and pre-litigation efforts, recovered more than $2 million on behalf of policyholders and groups over the last 18 months.
• Achieved more than $43 million in total combined recovery and savings in 2020 from fraud investigations through the work of Horizon’s Special Investigations and litigation teams.
• Closely collaborating with legal, government and law enforcement peers both in New Jersey and nationally to fight fraud, bring offenders to justice and protect premium payers.