Hoboken University Medical Center may stop accepting Horizon Blue Cross Blue Shield as in-network insurance as of June 1, and the same for Bayonne Medical Center as of May 1, unless the two sides can negotiate for agreeable reimbursement rates in a hurry.
That means that people with that insurance can still use the hospitals, but for non-emergency treatment they are unlikely to be reimbursed at the same rates as if the hospitals were in their insurance network.
Last week, Horizon officials blamed the situation on negotiations gone awry between them and CarePoint Health, the company that owns those two for-profit hospitals.
“There has been some confusion about who is responsible for the termination, but the facts are clear: CarePoint Health notified us last year that they were exercising their right to terminate the contract without cause,” said Kevin McArdle, public affairs manager for Horizon, in a statement to the Reporter last week. “We have put forward a number of reasonable offers to CarePoint and continue to hope that they will return to the negotiating table.”
“If we were to remain with Horizon, the city’s medical claims could increase by an estimated $5 million.” – Mayor Dawn Zimmer
However, it’s not so clearcut for patients who need non-emergency treatment.
CarePoint Health officials declined to comment this past week about the change, but in recent reports they said they will continue to seek to renegotiate a contract with Horizon.
For-profit hospitals have, over several years, dropped certain insurance companies if they could not negotiate what they believe are reasonable rates. They may still see the patients, but they are not covered in network.
For instance, the two hospitals stopped accepting Aetna as in network years ago.
According to a slide show by Hoboken city officials at a public meeting on Tuesday, Christ Hospital has not considered Horizon in network since mid-2015.
How the city is handling it
During a special City Council meeting to discuss the opening of a Trader Joe’s in Hoboken on Tuesday, April 26 at 7 p.m. (see other cover story), the City Council unanimously approved two agreements related to health insurance for employees.
“We are taking action to ensure that our employees and retirees have the best access to health care possible, and as a result we are proposing that the city approve transitioning our healthcare coverage and Third Party Administrator from Horizon to United HealthCare/UMR effective June 1,” said Mayor Dawn Zimmer in a letter to the council prior to the meeting.
At the hearing, talks were mostly lackadaisical, with council members interested in simply fine-tuning the details.
Because health costs for city workers was the major cost driver for the city’s $107 million budget introduced recently, the mayor says saving money is among the top priorities in the decision.
“If we were to remain with Horizon, the city’s medical claims could increase by an estimated $5 million, and employees would face higher payroll deductions and out of pocket expenses with all CarePoint Health facilities and physicians being out of network,” Zimmer said in a statement.
The benefits through United Health Care/UMR “mirror” that of Horizon, the administration said.
Approximately 3,000 city employees and retirees (including the police and fire employees) currently use the city’s health care provider and the city says United Healthcare has more doctors that are in-network than Horizon. That figure totals 700 providers, but 100 are only in-network with Horizon. Another 198 are not in-network with either Horizon or United Health Care.
At the meeting, 3rd Ward Councilman Michael Russo asked that the city look into how many of the 298 doctors that are out-of network city employees actually use. Those statistics were taken by the city based on doctor visits between March 2015 and February 2016.
The agreement came in two parts: a resolution for an agreement between the City of Hoboken and CarePoint Health, as well as the City and United Health Care/UMR.
After the hearing Business Administrator Quentin Weist clarified the significance of the agreement.
Weist said the agreement will last until December and required two votes, since currently CarePoint doesn’t have an in-network agreement with United Health Care.
“Hopefully by the end of the year they will,” he said.
Also, the role of UMR (a subsidiary of United Health Care), Weist explained, is to process claims by patients to determine how much the insurance company and the patient owe, depending on the procedure.
To confirm your benefits, which may change from person to person, contact your insurance provider.
Steven Rodas can be reached at email@example.com.