Newton Horizon split continues

Impacts Pike residents and Milford Heath and Wellness Center By Pat Morris NEWTON, N.J. — Horizon Blue Cross Blue Shield of New Jersey patients in Pike County may have to rearrange some of their health-care plans now that Newton Memorial Hospital has opted out of the insurer’s network. The hospital, which also operates the Milford Health and Wellness Center, officially terminated its contract with Horizon on July 22; a four-month extension of benefits meant that Horizon patients, including those with HMOs and no out-of-network coverage, could continue using the hospital until Nov. 22. As of that date, Newton Memorial Hospital is no longer in a contractual relationship with Horizon BCBS. This decision means that some patients will have to seek their care elsewhere. During and after failed negotiations, each side accused the other of greed, failure to negotiate in good faith, and abandoning patient welfare for financial considerations. The hospital said that Horizon grossly underpaid for services performed, especially in-patient and emergency services, and that it was financially unfeasible, and even irresponsible, for Newton Memorial to continue accepting low payments from the insurance company. Horizon claimed that the hospital was seeking to make up for cuts in government aid by overcharging the company. Either way, some patients stand to lose. While both sides say they are open to renegotiation, Horizon and Newton Memorial Hospital appear to be waging a war of words to enlist subscriber and community support. An article on the hospital’s Web site asks patients to continue to come to Newton Memorial Hospital if they have out-of-network benefits (even though that would be more expensive for the patient), to tell their doctors they want to use Newton Memorial Hospital, and to tell Bill Marino, president and CEO of Horizon, that they want the hospital in the Horizon network. It gives a phone number and e-mail address for Marino. “I don’t think Horizon cares about this community the way the hospital cares about the community,” said Jim Brand, the hospital’s public relations and government affairs coordinator. “Quite frankly,” he said, “we’re talking about our survival.” The hospital lost money during the past two years, he said, and it simply can’t afford what he categorized as insurer reimbursements that are less than the cost of treatment. According to Tom Senker, chief executive officer and president of Newton Memorial Hospital, Horizon customers make up about 20 percent of the hospital’s patient population. Dave Rikkola, vice president of finance and chief financial officer, says those numbers are lower when emergency room patients are factored out. Under the law, hospitals must treat patients with emergencies, as well as give in-patient treatment to patients admitted through the emergency room, regardless of their insurance. Those most adversely affected will be Horizon members with HMO, Medicare Blue Value and Medicare Blue Solutions. These plans do not allow for non-emergency use of out-of-network hospitals. These patients will have to use St. Clare’s Hospital, Hackettstown Medical Center, Morristown Medical Center or other facilities for non-emergency treatment. Horizon members whose plans allow for out-of-network services — including Horizon POS, Direct Access, PPO and Medicare Blue Access — can still be treated at Newton Memorial Hospital, but will pay higher out-of-pocket fees for using an out-of-network hospital. Medicare patients with Horizon as a secondary insurer will see no change, the hospital said. Some patients who were being treated at the time the contract was terminated can continue their treatment and still be covered. These cases include up to six months of postoperative care, up to a year of continued treatment for cancer, up to a year of psychiatric treatment and the duration of a pregnancy and up to six weeks after delivery. Contact Horizon Blue Cross Blue Shield and/or Newton Memorial Hospital directly with more specific questions.