March 1 Deadline Looms for South Jersey Network Access
Jefferson Health and Horizon Blue Cross Blue Shield of New Jersey have failed to bridge their differences in ongoing negotiations, prompting both parties to advise patients that three Jefferson facilities in South Jersey will exit Horizon’s coverage network on March 1 if a settlement is not achieved.
Insurers and health systems typically reach agreements before contracts expire. Philadelphia’s largest health system, currently facing substantial operating losses, has nonetheless adopted a markedly aggressive stance in its negotiations with insurance providers. Disruptions involving Jefferson’s Lehigh Valley Health Network and UnitedHealthcare occurred in two separate waves across last year and the current year.
Horizon Claims Jefferson Demands Will Cost Members Millions
An online portal established by Horizon for commercial policyholders indicated that accepting Jefferson’s terms would add over $185 million in expenses for Horizon participants over the subsequent three years, adding that New Jersey policyholders ought not to bear the burden of financial deficits incurred by Jefferson in Pennsylvania. Horizon, based in Newark, N.J., did not specify the percentage increase Jefferson is seeking.
A separate notice indicated that Jefferson had terminated its Medicaid contract with Horizon effective Sunday. State regulations in New Jersey nevertheless ensure that individuals can maintain in-network coverage at Jefferson facilities located in Cherry Hill, Stratford, and Washington Township through Feb. 28.
Jefferson Asserts Horizon Pays Other Hospitals Higher Rates
Jefferson shared its own perspective through online communications to patients. The health system asserted that Horizon pays other New Jersey hospitals 146% more on average for inpatient care and up to 89% more for emergency care.
The health system omitted any commentary regarding how rates vary across geographic regions, even though pricing tends to be elevated within the costlier New York metropolitan market. The health system stated that it wants Horizon to narrow the gap rather than make it the highest-paid system.
“Jefferson was in active negotiations with Horizon when they decided to abruptly cancel all discussions,” Jefferson said in a statement. “They’re putting patients well being at risk by refusing to continue conversations with us. We stand ready to meet with Horizon any time, any day, any location on behalf of our patients.”
State Law Allows Patients to Receive in-Network Care
Neither Jefferson nor Horizon revealed how many patients would be affected if they cannot agree to a new contract. Under New Jersey regulations highlighted by Horizon, individuals undergoing cancer treatment or psychiatric care will retain in-network access at Jefferson for a full year even if the contract lapses.
Meanwhile, in its dispute with Independence in Southeastern Pennsylvania, Jefferson is not focusing on local competitors. Instead, the health system is concentrating on what it describes as Independence’s underpayment relative to national averages for the entire market. Furthermore, Jefferson published a warning indicating that its services could be dropped from the network of Highmark—Pennsylvania’s primary Blue Cross Blue Shield provider—starting on Jan. 1.
