The Times, Trenton

Horizon Extends In-Network Coverage At Fuld By A Month

The Times of Trenton — Saturday, July 11, 2009


TRENTON — Patients of Helene Fuld Medical Center received a one-month reprieve yesterday when Horizon Blue Cross Blue Shield of New Jersey agreed to continue in-network coverage of its members who use the hospital until Aug. 16.

In letters to 92,000 members last week, Horizon had announced it would stop in-network coverage for treatment at Fuld after its contract with the Capital Health facility expires July 16 because of a dispute about reimbursement rates.

The extension gives Capital Health more time to work out a new contract with the insurer before its patients must begin paying higher out-of-network fees or switch to another hospital.

Letters from Horizon giving notice of the pending cancellation caused consternation among some of the thousands of current and retired state workers in the area who have been going to Fuld for decades.

"We've received calls from patients who are concerned about continuing to use Fuld and see their physicians, so we're working with Horizon so they can continue to have that choice," Capital Health spokeswoman Jayne O'Connor said. She said many patients called about the issue.

Cancellation threats are common during reimbursement-rate negotiations as insurers seek to ratchet up pressure on hospitals, though Horizon spokesman Dan Emmer declined to characterize the sending of the letters as a negotiating tactic.

"Whenever two sides are negotiating, there are bound to be disagreements that take more time to resolve," he said. "We talk to hospitals all the time, and what's happening is not uncommon."

But Emmer also said Horizon was not required to send the letters.

"We did this just to make sure our members were fully informed," he said.

In addition to canceling in-network coverage at Fuld for State Health Benefits Program members, Horizon said in-network coverage at Capital Health's Mercer campus would end for all its members Jan. 16, 2010.

The Mercer deadline is still in effect but could be withdrawn if the two organizations reach a new agreement in the coming months.

Horizon made similar cancellation announcements last fall, saying it would terminate contracts with the Children's Hospital of Philadelphia (CHOP) and the University of Pennsylvania Health System (UPHS).

Both of the Pennsylvania systems worked out deals with the insurer earlier this year, before the contracts expired.

If Horizon did cancel coverage at Fuld and Mercer, some patients could end up switching to St. Francis Medical Center on Hamilton Avenue in Trenton. Other covered hospitals include Robert Wood Johnson University Hospital in Hamilton and the University Medical Center at Princeton.

The 3.6 million-member insurer is seeking to rein in costs as it faces falling revenues and, for the first time in more than a decade, lagging enrollment. In May, it laid off 170 employees and eliminated 83 open positions, and said more layoffs could be in store.

The nonprofit insurer also cut advertising, travel and other administrative costs and limited salary increases.

Horizon last year asked state regulators to allow it to convert to a for-profit company, but the proposal remains under review and its prospects are uncertain.

Capital Health has prospered in recent years and is building a new $530 million medical center in Hopewell Township. The project broke ground in November.

The organization is spending $45 million to expand Fuld and plans to close most of the Mercer campus when the Hopewell facility opens in 2011.

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