What insurance do you have?

Bayonne hospital drops Horizon Blue Cross from in-network coverage

As of May 1, Bayonne Medical Center no longer accepts Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ) as in-network insurance. Starting June 1, Hoboken University Medical Center will follow suit unless CarePoint, which owns the two for-profit hospitals, and Horizon negotiate a contract.
Carepoint also owns Christ Hospital in Jersey City. Horizon BCBSNJ is the state’s oldest and largest health insurer and not-for-profit health service corporation.
Hospitals make agreements with insurance companies to offer lower rates as in-network providers in exchange for the insurance companies driving patients to those hospitals. When the hospital deems its reimbursement rates unfair, it drops the insurance company for leverage, and to test the market for better rates elsewhere.
In CarePoint’s case, its contract with Horizon had an automatic renewal clause, and, according to CarePoint spokesperson Jarrod Bernstein, CarePoint “did not exercise the automatic renewal clause at its current structure.”

Out-of-pocket costs

After CarePoint is out of Horizon BCBSNJ’s network, it will charge those with Horizon coverage higher out-of-pocket costs for non-emergency care. Out-of-pocket costs for emergency care do not change because insurance companies are required by law to cover emergency room visits at any hospital.
CarePoint is open to future negotiations. CarePoint’s Bernstein said, “CarePoint Health seeks to be in-network with every insurer in the state, including Horizon Blue Cross of New Jersey. We look forward to continuing to negotiate with Horizon to come to a resolution before our current contracts expire.”
Horizon BCBSNJ issued a press release about its relationship with CarePoint. “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 BCBSNJ. “We have put forward a number of reasonable offers to CarePoint and continue to hope that they will return to the negotiating table.”
Hudson County spokesman Jim Kennelly said, “People can go to another hospital if they had something that’s of a non-emergency nature. For example, the Jersey City Medical Center is not a part of CarePoint. They got a designation from Blue Cross as a tier 1 hospital, so they’re covered by Blue Cross for both emergency and non-emergency procedures.”

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“People can go to another hospital if they had something that’s of a non-emergency nature.” – Jim Kennelly
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99 percent of city employees covered by Horizon

Many Bayonne city employees will find that their insurance is no longer accepted at Bayonne Medical Center. Hudson County’s Kennelly said that Bayonne’s city employees get their “benefits through the state health benefits program. The plan most state employees have is NJ Direct 2030.” He added that “around 99 percent” of Bayonne’s city employees under the NJ Direct 2030 plan use Horizon BCBSNJ.”
Kennelly recalled that the two sides had a similar contract dispute a few years ago, which resulted in an eventual agreement. He hopes that CarePoint and Horizon do the same this time.
Bayonne Medical Center, which has been ranked as one of the most expensive hospitals in the nation, could pose a problem for out-of-network patients.
Urban hospitals have struggled with reimbursement rates because insurance companies tend to require larger discounts from urban hospitals than from suburban ones. By law, insurance companies are allowed to negotiate different rates with different hospitals. That could be bad for the consumer, since hospitals do not provide a menu of treatment options and prices. Imagine going to buy a burger, but not knowing if that burger will be $6 or a few thousand.
To confirm your benefits, which may change from person to person, contact your insurance provider. It is best to keep a record of the call and the person to whom you spoke.

Rory Pasquariello may be reached at roryp@hudsonreporter.com.

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