CarePoint, Horizon settle $76 million legal fight with in-network deal

BAYONNE — CarePoint Health has entered into a new three-year agreement with Horizon Blue Cross Blue Shield, ending a $76 million legal battle with the state’s largest insurer and providing more in-network hospital options for thousands in Hudson County.
Officials with the for-profit healthcare company said the deal — which puts Bayonne Medical Center, Christ Hospital in Jersey City and Hoboken University Medical Center in-network — goes into effect on Oct. 1.
“We are excited to partner with Horizon to move healthcare forward in northern New Jersey,” said CarePoint Health CEO Jeff Mandler. “This agreement allows CarePoint to continue to invest in our people and infrastructure while ensuring care for the most vulnerable among us.”
The agreement is a boon for public employees across Hudson County, since most, if not all, are covered by Horizon Blue Cross Blue Shield policies.
The new deal marks the end of a heated legal battle between the two companies over unpaid and underpaid medical bills since June 2015. It also comes less than a month after RWJ Barnabas Health opened a Jersey City Medical Center satellite emergency department and other medical offices roughly six blocks from the BMC.
Last September, CarePoint Health filed a $76 million lawsuit to collect on what it said was unpaid and underpaid medical bills; the company said the money it sought represented the balance of roughly $115 million in billings submitted to Horizon of which the company only paid $39.6 million.
CarePoint also said Horizon had repeatedly denied reimbursements for patients treated in the emergency room in violation of a law that protects patients from massive medical bills and requires insurance companies to pick up the tab.
Horizon fired back at the healthcare company, citing the company’s history of price gouging, while also threatening its own lawsuit.
CarePoint hospitals have been held up as one of the most expensive hospitals in the nation based on their charges, or the out-of-network prices people paid while visiting the hospitals, according to an analysis by the National Nurses United conducted in 2014.
The company did not renew the BMC and HUMC in-network agreements with Horizon in June 2016 and the Christ Hospital agreement in 2015 — citing insufficient reimbursement levels.
The new deal ends almost a year of continued negotiations between the two companies.
“We’re pleased about reaching a new rate agreement with CarePoint, which will provide our members with additional options for in-network health care services,” said Allen J. Karp, senior vice president of Healthcare Management for Horizon.

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