Channel Sponsor - Coding/Billing/Collections

Sponsored by National Medical Billing Services | info@nationalASCbilling.com | (636) 273-6711

Horizon Blue Cross Files Two Lawsuits Against New Jersey Hospitals for Out-of-Network, Fraudulent Billing Practices

Share on Facebook

Horizon Blue Cross Blue Shield of New Jersey has filed two lawsuits against two separate hospitals over billing practices at the facilities, according Horizon news releases.

Horizon filed a Complaint for Injunctive and Declaratory Relief against Bayonne (N.J.) Medical Center, claiming that the hospital charged "exorbitant fees and misrepresenting its fees for services" and defrauded the Horizon after the hospital left the network in February. Horizon said in the release that BMC increased its aggregate daily charge from $13,000 to $29,000 and said it would not collect any out-of-network fees owed by Horizon members.

Horizon also filed an answer and counterclaim to a suit filed by Newton (N.J.) Memorial Hospital. The counterclaims states that Newton prevented Horizon from contacting its members to inform them of less expensive services at competing hospitals and to advise them of their contracted benefits with Horizon, and refused Horizon's request for medical status of members so that the insurer could determine if the patients could be transferred to another facility. Horizon also claimed that physicians at the hospital "engaged in a pattern and practice of blocking Horizon from determining the medical necessity and appropriateness of care provided by Newton," according to the release.

In a separate lawsuit, Horizon alleges that Newton fraudulently billed Horizon by "waiving patients' financial liability, including coinsurance and deductibles, as well as other costs," after the hospital ended its contract with the insurer. Horizon also claimed that Newton's actions drove up healthcare costs for Horizon's 3.6 million members.

Read the release about the Bayonne out-of-network lawsuit.

Read the release about the Newton Memorial lawsuits.

 

© Copyright ASC COMMUNICATIONS 2014. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

New From Becker's ASC Review

11 top-rated insurers for fewest denials

Read Now