NJ hospital, Blue plan in ugly legal dispute

Man, oh man. If real patients' well being weren't at stake here, the dispute between Bayonne (NJ) Hospital Center and Horizon Blue Cross Blue Shield of New Jersey would almost be entertaining, so nasty are the charges.

Bayonne, on the one hand, charges that Horizon is literally scaring its patients out of hospital beds. Horizon, meanwhile, claims that BHC is attempting to drain them of their bottom dollar.

The first shot in the legal battle between the two began a few months ago, when Horizon filed a lawsuit accusing BHC of fraud. Horizon claims that BHC had doubled its aggregate per-day charges from $13,000 in 2008 to $29,000 in 2009 since it was kicked out of the Horizon network. It also says BHC isn't collecting out-of-network fees from Horizon members, which means it is overbilling the health plan.

Bayonne has fired back with a sensational suit charging that Horizon has been engaging in unethical business practices. It asserts that among other things, Horizon has been sending couriers to the hospital with letters telling the patient that they need to be transferred to an in-network hospital, or that they should go home. (Horizon has supposedly sent couriers with letters telling patients they were stable and transferable even to the BHC intensive care unit.) The Horizon reps are telling patients that if they don't comply, the health plan won't pay its share of the bill, BHC claims.

To learn more about the dispute:
- read this Health Leaders Media piece

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.