Insurers Release Study on Out of Network Costs

Yesterday Horizon Blue Cross released the results of a study it paid for that concludes that insurers are paying too much to physicians and hospitals that don’t participate in its network. Horizon also suggested it could lower premiums if NJ’s important consumer protections were repealed.

Horizon is a financial juggernaut. The company made $214 million net of expenses in 2013 according to its published financial statements, that’s $10 million better than they did in 2012. The company (a non-profit) has reserves over $2.5 billion. It seems they have some room to lower premiums now.

What Horizon failed to say is that they have the ability to contract with all physicians and hospitals in the state, but they choose not to. New narrow network plans exclude physicians that want to treat patients. So in effect Horizon is contributing to the problem they seem so desperate to fix.

Dialog on the financing of healthcare in NJ is sorely needed. But the laser focus on out of network payments is unfounded.


About MSNJ

Founded in 1766, the Medical Society of New Jersey is the oldest professional society in the United States. The organization and its dues-paying members are dedicated to a healthy New Jersey, working to ensure the sanctity of the physician–patient relationship. In representing all medical disciplines, MSNJ advocates for the rights of patients and physicians alike, for the delivery of the highest quality medical care. This allows response to the patients’ individual, varied needs, in an ethical and compassionate environment, in order to create a healthy Garden State and healthy citizens.

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