Coalition Calls On Legislature To Hold Insurance Companies Accountable For Access To Care For All

Princeton, NJ /PRNewswire-USNewswire/ - The NJ Access to Care Coalition (NJACC), a coalition of physicians, hospitals and other healthcare providers, is calling on the New Jersey Legislature to hold health insurance companies accountable as they limit access to care for their beneficiaries.

Horizon Blue Cross & Blue Shield of New Jersey – with a 2013 net income of $214.1 million (an approximate 7 percent increase over prior year) and $2.67 billion in capital reserves as of Dec. 31, 2013 – recently paid for a report that attempted to justify recommendations that would cap the amount a hospital and physician can be paid for services delivered to patients. The report is critical of a state law that protects patients who present in an emergency department, but are seen by an out-of-network provider. This consumer protection holds the patient to the same cost-sharing obligations as if the patient were seen by an in-network provider.

"New Jersey state law protects patients who, by no choice of their own, are seen by an out of network provider in an emergency situation," said Betsy Ryan, president & CEO of the New Jersey Hospital Association. "Imposing rate setting measures on healthcare providers does nothing to improve access to care for patients; caps protect insurers, not patients. Instead of capping payments to providers, the health insurance industry should be focused on bringing more providers into their networks and providing better access to care for their members. Rate setting is a vestige of the past."

Providers across the continuum are being squeezed out of insurance networks because of lower payment rates for services and the push for narrow networks. Physicians' and hospitals' only recourse to negotiate adequate payment rates is to have the ability to walk away from the table and go out of network with the insurer.

"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," said Lawrence Downs, Esq., CEO of the Medical Society of New Jersey. "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."

Dr. Jon Lustgarten, a neurosurgeon who testified on behalf of the New Jersey Neurosurgical Society before the Assembly Financial Institutions and Insurance Committee in October said, "It's certainly our perspective that we have an in-network problem, not an out-of-network problem. If financial pressures become too great, neurosurgeons will choose not to practice.

"With a few exceptions, insurers are interested in building networks that are as small as possible, with the lowest-paid providers. Instead of proposing solutions to improve their own financial situation, the health insurance industry should come to the table with a solution that benefits the patient."

As healthcare providers, the number one priority is to provide quality care to patients. Insurance companies provide more barriers than solutions to access to care, as is evidenced by their tactics in attempting to resolve the out-of-network debate with payment caps. Patients and providers are already forced to rely on insurance companies for coverage and payment, and should not be forced to accept a lesser quality of care because the plans want a one-sided solution to a problem that affects everyone.

David Abramson, MD, FACS, president of the New Jersey Society of Plastic Surgeons states that the Society, "supports efforts to inform patients when their practitioner is out-of-network. Both physicians and health insurance carriers should work together in order to identify reasonable reimbursement rates for procedures. It is important to recognize reasonable rates should be based on national non-proprietary reimbursement databases. Any effort to reform out-of-network benefits must be transparent and focus on preserving quality care, patient access and affordability."

The NJ Access to Care Coalition members include:

• New Jersey Hospital Association
• Medical Society of New Jersey
• Radiological Society of New Jersey
• New Jersey Association of Osteopathic Physicians and Surgeons
• New Jersey Podiatric Medical Society
• New Jersey Society of Pathologists
• New Jersey Neurosurgical Society
• New Jersey Academy of Family Physicians
• New Jersey Orthopedic Society
• New Jersey Society of Plastic Surgeons
• New Jersey Association of Ambulatory Surgery Centers
• NJ Society of Interventional Pain Physicians