Horizon says St. Joseph’s Health is leaving network
Listen to this articleThe basics:
- Horizon says St. Joseph’s Health hospitals will go out of network March 1, 2026
- Impacted facilities include hospitals in Paterson, Wayne; system’s medical group
- St. Joseph’s cites inadequate reimbursement rates amid rising health care costs
- A four-month continuation period keeps Horizon members covered while talks continue
Hospitals within St. Joseph’s Health system will soon no longer be considered as in-network providers by Horizon Blue Cross Blue Shield of New Jersey, according to the health insurance company.
In a recent announcement, Horizon said St. Joseph’s University Medical Center in Paterson and St. Joseph’s Wayne Medical Center in Wayne will leave the network March 1, 2026. The move would also affect the hundreds of providers within the Paterson-based system’s medical group, according to St. Joseph’s Health.
“Horizon has been working to reach an agreement with St. Joseph’s Health (St. Joseph’s) hospitals to stay in the Horizon Hospital Network. Unfortunately, we have not reached an agreement,” the insurer said.
Footprint
Besides the two hospitals, St. Joseph’s Health’s footprint includes a state-designated children’s hospital in Paterson as well as an outpatient facility and cancer center in Totowa.
It also has comprehensive home care; multiple ambulatory care centers; and a medical group with more than 350 primary and specialty care doctors, nurse practitioners and physician assistants at over 65 locations across North Jersey.
According to St. Joseph’s Health, nearly 100,000 patients have used its facilities or received care from its medical group over the past 18 months.
In a Q&A posted on its website, the system wrote:
At St. Joseph’s Health, the health and well-being of our patients and communities is our highest priority. We work with third-party insurers like Horizon Blue Cross Blue Shield to help ensure that our patients have access to the highest-quality care available at a cost that is affordable. Regular contract negotiations are an important part of this work.
Unfortunately, Horizon’s current reimbursements to St. Joseph’s Health have not kept up with inflation and are overwhelmingly inadequate to account for the cost of providing safe and quality care. We have negotiated over the past several months in good faith – and continue to do so – to secure fair reimbursement rates that help maintain the long-term sustainability of our health care organization, protect your ability to receive care from us and avoid any unnecessary care disruptions.
A care-ful approach
While St. Joseph’s Health notified the carrier that it is terminating the contract, Horizon spokesperson Thomas Wilson said the two “have a long and positive relationship and are still working together to reach an agreement.”
In a statement, St. Joseph’s Health said it is “in good faith with Horizon Blue Cross on a new contract that is sustainable, protects patient access and avoids unnecessary disruptions.”
St. Joseph’s Health said the system remains in network with the following major commercial insurance companies:
- Aetna
- AmeriHealth
- Clover Health
- Fidelis Care
- United Healthcare
- WellPoint
“Unfortunately, Horizon Blue Cross continues to insist on rates that are inconsistent with others and fail to reflect the true cost of delivering safe, high-quality care,” it said. “As a non-profit, mission-based organization, we treat everyone who comes through our doors regardless of ability to pay. That mission remains steadfast. Our ask of Horizon Blue Cross is that we are reimbursed at equitable rates. We are confident that together we will find a resolution that ensures our community can continue to receive the exceptional care it deserves.”
For now, patients who participate in Horizon Medicaid, Medicare, exchange and commercial plans are not affected. Although the current agreement has ended, a four-month continuation period allows St. Joseph’s Health to care for Horizon members under the terms of the expired contract while discussions continue, the system said.
St. Joseph’s Health is also urging patients to explore their insurance options to ensure that they can continue to see trusted providers.
Earlier this year, Hackensack Meridian Health nearly went out of network with Horizon during negotiations. However, the parties reached a new multiyear contract that allowed Horizon members to continue accessing HMH’s 18 hospitals statewide.
The dispute centered on reimbursement rates, with HMH seeking higher payments and Horizon arguing the increases would drive up costs for members.
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