On November 1st the New Jersey Department of Banking and Insurance will rule on whether New Jersey Blue Cross/Blue Shield health plans may use an outside 3rd party company to authorize or deny various forms of physical medicine for providers. There has been heavy lobbying by the insurance carrier in an effort to legally not fund treatment deemed necessary by licensed NJ doctors, therapists and acupuncturist.
Most plans cover somewhere around 30 visits for some sort of physical medicine. Subscribers pay for these visits from either wage garnishes, out-of-pocket payments or from their funded retirement plans. In an effort to save costs Horizon is looking to contract with an out-of-state third party provider who will “review” all claims which includes sending providers a plethora of paperwork to justify care. The company they have chosen has a reputation of denying the insured visits they have rightfully paid for as well as have been deemed medically necessary by providers licensed and vetted by the State of New Jersey. In fact this outside company recently settled out of court for $11.8 million because they were denying subscribers reimbursement for necessary treatment.
So where does this leave New Jersey and the power of the people versus corporatism and lobbyist? As of last month the Governor received over 170,000 emails from concerned citizens asking that this agreement not be approved. Various Assemblypersons and Senators are against it, while some wish to remain silent or actually support this insurance company mission. If the NJDOBI green lights this relationship, those with Blue Cross Blue Shield coverage would be left paying for health care they cannot access.
In the coming weeks we will see if the alliance between corporate sweetheart deals and political favors wins the day…..or should I say loses the day for 3.7 million New Jersey residents.