Out-of-network providers are taking advantage of Horizon Blue Cross Blue Shield of New Jersey, Horizon CEO Robert Marino told the New Jersey Business Journal. For instance, an out-of-network cardiologist performed a pulmonary stress test on a patient and billed the insurer for $12,500. This procedure generally costs about $90. Another time, a pain management physician performed a blood draw and stuck the insurer with a bill of $650. This usually costs Horizon about $4.
While this may be "just one small wrinkle in the debate between insurers and out-of-network providers," Marino said it costs the insurer hundreds of millions of dollars a year while also increasing premiums. He did make clear, however, that "we're talking about a small number of out-of-network physicians that are really driving this problem and have really come to understand how they can capitalize on a regulation that requires us to pay out-of-network charges." Under New Jersey law, patients who receive care in emergency situations are not responsible for out-of-network costs. Article