Thursday, May 1, 2008

Hospital, Blue Cross Talks Stall


from the New Jersey Herald

NEWTON — Newton Memorial Hospital patients insured by Horizon Blue Cross/Blue Shield received notice late last week that the hospital intends to terminate its contract with Horizon.

"It is the bigger picture that brings us to this point with Horizon. It is the environment of hospitals in the state," said Newton Memorial's Sean O'Rourke, chief operating officer. "Everybody in New Jersey is dealing with it."

The decision came about after several attempts were made by the hospital to negotiate a contract that would provide what it considers more appropriate payment rates for its services.

"This is not new," O'Rourke said, "We have talked with more than 20 insurance companies over the last 18 months. Getting to this point helps both parties focus on the task at hand."

The letter, signed by President and Chief Executive Officer Thomas Senker, stated, "Although this letter will alert Horizon of our intentions, Newton Memorial will continue to negotiate in good faith for rate adjustments to sustain high quality care and accessibility to modern and efficient health care facilities for you and your family."

Horizon Blue Cross/Blue Shield executives did not return phone calls seeking comment.

Under the terms of the current contract, the hospital is in-network with Horizon. The hospital said it will continue to negotiate rate adjustments so that it can sustain care and accessibility to health care facilities for its patients.

The contract states that those who subscribe to Horizon still will be able to utilize their in-network benefits at Newton Memorial Hospital for 90 days, until July 22. After that, Horizon members can continue to go to Newton Memorial Hospital to receive out-of-network services. The reimbursements will depend on individual health plans.

Patients who have HMO coverage will remain in-network for four months after the termination of the contract, until Nov. 22.

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