Hackensack Meridian, Horizon hospital dispute could hit patients
A contract impasse between New Jersey’s largest medical insurer and the state’s largest hospital network could put thousands of patients in medical limbo this summer.
Coverage provided by Horizon Blue Cross Blue Shield of New Jersey will continue for the next four months at Hackensack Merdian Health hospitals, potentially allowing time for the sides to hammer out a deal.
But on Thursday, they appeared to be far apart.
Hackensack Meridian will terminate Horizon in-network benefits on June 1 unless the insurer agrees to higher reimbursement rates, said Tom Wilson, a spokesman for the insurance company.
“Horizon is offering a fair and reasonable price increase,” Wilson said, but argued that Hackensack Meridian “is demanding an increase that is much higher than the rate of inflation.”
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Horizon’s proposal includes “inadequate reimbursement rates” and “significant changes” to previously agreed-upon contract terms, countered Jessica Nussman, a spokeswoman for the Hackensack Meridian hospital network.
Hackensack Meridian “must receive fair care reimbursements from Horizon to continue to invest in the care, medical technology, and locations that the local communities we serve rely on and expect,” Nussman said in a statement.
Hospital-insurer disputes aren’t new, but now impact more patients
Contract disputes over how much insurers will reimburse hospitals for care is not a new phenomenon. But as hospital networks and insurance companies merge, the impact of an impasse becomes widespread, forcing more patients to seek care elsewhere or pay significantly higher out-of-network fees.
Horizon covers more than 3 million New Jersey residents. Hackensack Meridian operates 18 hospitals across the state, including some of the largest, such as Hackensack University Medical Center and Jersey Shore Medical Center in Neptune. It was not known Thursday how many Horizon customers would be affected.
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A contract impasse also has greater impact on hospitals and insurance companies with millions of dollars at stake daily if the sides don’t come to an agreement. Aetna and Hackensack Meridian agreed to a new contract last year — less than two weeks before it was to expire.
Neither side would say what the specific points of contention are between Hackensack Meridian and Horizon.
Hackensack Meridian said its demands are similar to those agreed upon in recent years by other insurance companies. Horizon said Hackensack’s prices have increased by more than the rate of inflation over the past five years and “is already among the most expensive hospital systems in New Jersey.”
If an agreement is not reached, it would affect only hospitals. It does not affect Hackensack Meridian primary care and specialty physician practices. It also does not affect Horizon customers covered by a Braven Health, Medicaid or Medicare policy.
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