Thursday, July 23, 2009

Urgency of public option: Horizon Blue Cross Blue Shield of NJ sued for engaging in "life threatening business practices"

Press Release:

Bayonne Hospital Center and Hospital Patient File Federal Lawsuit to Protect Bayonne, New Jersey Residents From Life-Threatening Business Practices of Horizon Blue Cross Blue Shield of NJ

Suit Charges Horizon with Systematic Attack on Emergency Care in Quest for Profit

BAYONNE, NJ, JULY 22, 2009Bayonne Hospital Center (BHC)—the only hospital in the medically
underserved working class community of Bayonne, NJ—today announced it has filed a federal lawsuit against
Horizon Blue Cross Blue Shield of New Jersey (Horizon), the largest provider of health insurance in the state. The
lawsuit was filed in an effort to halt Horizon’s illegal, fraudulent, egregious and unethical business practices which
are endangering the lives of the citizens of New Jersey and threatening Bayonne Hospital Center’s financial
viability, all in the name of boosting its own bottom line and prospects for an initial public offering.

Horizon’s practices and activities include, among other things: a systematic campaign of intimidating patients into
abandoning emergency care at BHC that is already underway, including calls to patients and the sending of couriers
to instruct patients to leave the hospital while still in the midst of emergency treatment; egregious and arbitrary
denials of coverage and claims for emergency care at BHC; and constant efforts to under-compensate the only
emergency care option in the Bayonne community, a hospital just rescued from bankruptcy.

The complaint filed today in the U.S. District Court in Newark, New Jersey provides a detailed account of
Horizon’s business practices which run counter to the insurer’s contractual duties to its customers, its obligations
under state law and its stated commitment to the interest of public health. Some of the most offensive Horizon
practices detailed in the complaint include:

• A systematic campaign discouraging patients from seeking emergency care at BHC despite it being the
closest and safest option for urgent care for the residents of Bayonne
• Intimidation of patients by threatening denial of coverage if they seek treatment at BHC
• Interference with care by sending couriers to BHC to tell patients undergoing medically necessary
treatments to leave BHC and seek care at a hospital that is “in network”
• Indefensible denial of claims, often while the patient is still undergoing care
• Unilateral determinations by Horizon bureaucrats that emergency room patients are medically stable
enough to be discharged to home or transferred to other in-network facilities without consulting the
patient's attending physician

The complaint not only details Horizon’s atrocious behavior and policies with BHC, but also exposes Horizon’s
multi-billion dollar financial success at a time when New Jersey’s hospitals cannot afford to provide healthcare to
the communities which they serve. The complaint also reveals Horizon’s gold-plated executive compensation
packages and its publicly stated plans for conversion to a “for profit” entity and initial public offering.
Joining the suit as a plaintiff is Dr. John Godinsky, a Horizon customer who was admitted to Bayonne Hospital
Center through its emergency room for atrial fibrillation (irregular and often rapid heart rhythm). While still in the
hospital, Horizon contacted Dr. Godinsky and Bayonne administration to inform him his stay was being denied
based on what Horizon erroneously claimed was a pre-existing condition. Against the advice of his attending
physicians, Dr. Godinsky left the hospital fearing the large financial obligation associated with the uncovered stay.
Given the cavalier manner in which Horizon attempts to steamroll hospitals into accepting grossly inadequate
reimbursement rates and payment policies, it should come as no surprise that approximately half of the hospitals in
New Jersey are losing money. Perhaps even less surprising is the fact that Horizon is petitioning to become a “for
profit” entity, clearing the way for an initial public offering and a big payday for its executives.

Commenting on today’s announcement was Daniel Kane, CEO of Bayonne Hospital Center who said, “Ultimately,
Horizon’s attacks are not on hospitals but on the communities they serve. Their relentless assault on patients,
doctors and hospitals for the sake of their own profits is a prime reason that New Jersey ranks last in the country for
emergency rooms per capita. Neither this hospital nor the people of Bayonne will be bullied by Horizon. BHC filed
this case to fight for patients’ rights for quality health care and hopes that other hospitals will do the same in their
conflicts with Horizon.”

A copy of the complaint can be found online at
Bayonne patients with questions about their insurance being accepted at the hospital should call their Insurance
Hotline at 201-858-7342.

About Bayonne Hospital Center
Established in 1888, Bayonne Hospital Center is a 278-bed, fully accredited, award-winning acute-care hospital
located in Hudson County. Since opening its doors more than a century ago, it has been committed to providing
quality, comprehensive, community-based healthcare services to more than 70,000 people annually. With its finger
on the pulse of the community, Bayonne Hospital Center continually develops new and expanded services to meet
the changing needs of the people it serves. For more information about Bayonne Hospital Center, visit the hospital
online at

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