Newspaper article The Record (Bergen County, NJ)

Hospitals Battle with Insurer

Newspaper article The Record (Bergen County, NJ)

Hospitals Battle with Insurer

Article excerpt

Hardball negotiations between the state's largest health insurer and Passaic County's largest hospital system have spilled into the public, with St. Joseph's Healthcare System condemning Horizon Blue Cross Blue Shield of New Jersey as "a big bully insurer" in newspaper ads and Horizon sending letters to dozens of Passaic County doctors, terminating them from its network.

The battle over next year's contract could affect tens of thousands of patients with Medicaid and FamilyCare coverage, state employee benefits, individual, small-business and commercial plans, and Medicare.

Nearly 42,000 Passaic County residents had Horizon coverage as of June 30. It is the single largest payer at the St. Joseph's system, which includes the 651-bed regional medical center in Paterson and a 229-bed community hospital in Wayne.

Despite the brinksmanship, it's possible that the contract will be resolved before Jan. 1. But state law requires insurers to notify physicians if their contracts will be terminated and to notify members of a change in coverage.

"The vast majority of these termination notices do not lead to actual termination of the contract," said Marshall McKnight, a spokesman for the state Department of Banking and Insurance.

The department has been notified of 26 such potential terminations so far this year, but some of them were resolved before the insurance customers received letters and only one -- a contract between AmeriChoice and Hackensack University Medical Center -- led to an actual termination, he said. Seven of the notices the department received involved Horizon contracts.

Horizon's termination letters this time went to doctors with admitting privileges solely at St. Joseph's. They will no longer be considered network providers.

Each side claims it has the public's interests uppermost: Horizon says it's trying to keep its customers' premiums as low as possible, and St. …

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