NEWTON, N.J. (CN) – After a quarrel over reimbursement rates, Newton Memorial Hospital claims that Horizon Blue Cross Blue Shield of New Jersey “harassed physicians” and “urged admitted patients to leave Newton immediately” by calling them at bedside and “delivering false and misleading letters.” Included among the letter recipients was “a senior citizen admitted through the emergency room with double pneumonia and multiple complications.”
Newton Memorial, the only full-service community hospital in Sussex County, says it had to quit Horizon’s health insurance and payment network this year due to “woefully inadequate reimbursement rates” which caused the hospital to lose money.
After the contract ended, Horizon began the “wrongful tactics which are intended to force Newton to capitulate and rejoin the Horizon network,” the hospital claims in Sussex County Court.
The hospital says Horizon Blue Cross Blue Shield delivered the misleading letters “to patients at their hospital bedsides by hand, which purported to deny existing medical coverage.”
Newton Hospital claims the harassment didn’t stop there. It says Horizon also telephoned patients and told them to leave, “through misrepresentations as to the severity of their medical condition and threats as to their personal financial responsibility for their hospital bills.”
The hospital says that Horizon threatened to terminate and did terminate “contracts of certain physicians and physician groups in retaliation for … referring their patients to Newton.”
The hospital seeks reimbursement for more than $1 million in unpaid medical expenses. It is represented by Shawn Kelly with Riker, Danzig, Scherer of Morristown.