13:57 PM

Christ Hospital terminates its longstanding relationship with Horizon Blue Cross Blue Shield of New Jersey

Horizon Blue Cross Blue Shield of New Jersey began notifying members this week that Christ Hospital, owned by the for-profit CarePoint Health company, has terminated its longstanding relationship with the state’s largest health insurer. In accordance with state regulations, Horizon BCBSNJ is sending notices to more than 146,000 members in the Hudson County area advising that Christ Hospital will no longer be in Horizon BCBSNJ’s hospital network as of June 1, 2015. Horizon BCBSNJ members will be subject to higher out-of pocket costs when using Christ Hospital after that date."The affordability of health care in New Jersey is a paramount concern of our members," said Robert A. Marino, chairman and CEO of Horizon BCBSNJ. "We strive to work with all New Jersey hospitals in order to provide our members with the best access to quality, affordable care, which is why we are disappointed by CarePoint’s decision to have Christ Hospital leave our hospital network."Horizon BCBSNJ serves more than 3.7 million members. The Horizon BCBSNJ hospital network currently includes 62 of the state’s 64 hospitals.Horizon BCBSNJ negotiates rates for the services provided to its members with network hospitals. When seeking treatment from network hospitals, members generally reduce their out-of-pocket costs because of the lower rates agreed to by network hospitals and Horizon BCBSNJ for their hospital care."Horizon works hard, on our members behalf, to negotiate reasonable and fair reimbursement rates with our network hospitals to keep health insurance affordable," said Kevin Conlin, Executive Vice President of Health Care Management for Horizon BCBSNJ. "Occasionally, as is the case with Christ Hospital, those negotiations are not successful. Therefore, Horizon has begun notifying our members in the area that seeking care at Christ Hospital after May 31 will mean higher out-of-pocket costs for them. We are also informing our local members about other affordable network hospitals available to them."Out-of-network hospitals generally charge members rates well above those agreed to by network hospitals. New Jersey law does not regulate what out-of-network hospitals can charge for patient care. Under state regulations, insured individuals, who receive emergency care by out-of-network hospitals, are only responsible for paying the amounts they would owe if treated at a network hospital. Insurance companies generally must pay the balance. Some out-of-network providers have taken advantage of this regulation to charge substantially higher rates for services resulting in higher health care costs for everyone. Last year, Horizon BCBSNJ paid more than $1 billion in out-of-network costs."We are hopeful that the owners of Christ Hospital will meet with us to negotiate in good faith and decide to return to the family of Horizon network hospitals," Marino added. "We believe in establishing fair and reasonable rates with hospitals for the quality health care services they provide to our members."Horizon BCBSNJ members will continue to have access to other local hospitals in the Horizon Hospital Network, which can be found in the provider directory on HorizonBlue.com.About Horizon Blue Cross Blue Shield of New JerseyHorizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, and prescription insurance products and services. Horizon BCBSNJ is leading the transformation of health care in New Jersey by working with doctors and hospitals to deliver innovative, patient-centered programs that reward the quality, not quantity, of care patients receive. Learn more at www.HorizonBlue.com. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.7 million members.