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NJ residents insured by Horizon set to lose coverage for state’s largest hospital network in June
By
Caroline Lewis
Published Jan 31, 2025
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Tayfun Coskun/Anadolu Agency via Getty Images
By
Caroline Lewis
Published Jan 31, 2025
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New Jerseyans covered by Horizon Blue Cross Blue Shield are on a course to lose in-network coverage for hospitals run by Hackensack Meridian Health in June. But there’s still a chance that the move announced on Thursday could be reversed if the two health care giants resolve their dispute over rates.
Hackensack Meridian is New Jersey’s largest hospital network, with 18 medical centers across the state, including Hackensack University Medical Center, Bayshore Medical Center and JFK University Medical Center.
Hackensack also has a large physician network, but doctors will remain covered. The split will only affect those with commercial insurance through Horizon, not patients with a Medicaid, Braven Health or Medicare plan.
Neither Hackensack nor Horizon said how many patients would be affected, but Horizon covers about 3.7 million total members.
Hackensack and Horizon have been negotiating over payment rates for the past year and have not yet been able to reach an agreement.
In a statement on Friday, Hackensack called Horizon’s proposed reimbursement rates for hospital services “inadequate” to cover the medical technology and care patients rely on.
Horizon countered in its own statement that Hackensack was seeking “significant price increases” that could ultimately result in higher premiums and out-of-pocket costs for patients. Horizon added that Hackensack’s price hikes in recent years have exceeded inflation.
Still, both parties said they would continue working to reach an agreement.
Hospitals and health insurers routinely negotiate over rates to be paid for services. But in recent years, it has become increasingly common for them to publicly threaten to end their contracts entirely, creating anxiety for patients. Some of these disputes escalate to the point where they disrupt care, while others are resolved at the last minute.
Hackensack Meridian threatened to cut ties with Aetna over a similar billing fight last year, but they ultimately reached a deal just two weeks before their contract was set to expire.
Patients left in limbo often have to decide whether to start looking for new health care providers.
If the dispute isn't resolved, some patients may still be able to extend their coverage a little longer, including those who are pregnant or recovering from surgeries.
Both New Jersey and federal law require health plans to allow patients in the midst of care for certain medical conditions to continue seeing their health care providers at the same in-network rates for a period of time after a contract is terminated.
Tagged
economy
new jersey
Health and Science
Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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