Setting the Record Straight on Horizon BCBS

Dr. Wax writes columnist Susan Livio  in repsonse to her February 16, 2106 article, “See why Horizon paid $3M in bonuses to N.J. doctors.” 

Dear Ms. Livio

Your article on Horizon insurance’s program to incentivize physicians was not a balanced view of the program or company.  It also misrepresented the so-called “affordable care act.” Neither entity has done anything to bring down the high cost of health insurance but to force Americans to buy it from profiteering high overhead entities under penalty of law.

Horizon Blue Cross Blue Shield of New Jersey is notoriously one of the most difficult insurance companies to deal with. Their denial rates for payment, denial rates for medications and tests, and poor communications skills are just a few of their issues. Both their patient and “provider” help desks are located off shore in the Philippines or India, despite their massive holdings in the state of New Jersey. One must not forget their bankruptcy in the 1990s, where they were forced to change their company from New Jersey Blue Cross Blue Shield to “Horizon.” 

In order to participate in their network performance program, a practice has to spend time and money achieving and maintaining “primary care medical home,” status. This adds to the cost of care and is certified by insurance industry boards, not individual physicians.

Horizon is currently being sued by multiple hospitals and other entities over their use of tiered networks in their “omnia” program. Horizon keeps their hold on New Jersey state employee benefits by virtue of their politics and payoffs, not competitive service. In the end, do you really want the federal government or your insurance company telling you what you must do in your daily routine and habits, or are you adult enough to “mind your own business,” and except the benefits and shoulder the burdens?

Feel free to contact me anytime if I can help with your future healthcare, reimbursement, or health policy articles.

Best wishes for good health,
Craig M. Wax, DO
Family Physician
Host of Your Health Matters
Rowan Radio 89.7 WGLS FM
Twitter drcraigwax

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