New Jersey Senators Ask Health Insurer To Negotiate In Good Faith New Contract With Children's Hospital Of Philadelphia

Main Category: Health Insurance / Medical Insurance
Also Included In: Pediatrics / Children's Health
Article Date: 03 Nov 2008 - 0:00 PST

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Due to concerns about New Jersey's largest health insurer terminating its contract with the Children's Hospital of Philadelphia and the effect it will have on children's health care, U.S. Senators Robert Menendez and Frank Lautenberg today called on the CEO of Horizon Blue Cross Blue Shield of New Jersey to actively and in good faith negotiate a new contract with CHOP. In September, Horizon canceled its contract with the hospital and its health care network, meaning that tens of thousands of New Jersey children who seek treatment - particularly specialized treatment - would no longer be covered at CHOP or its affiliates.

"We are very concerned about this termination since a number of children living in New Jersey may lose the access to pediatric subspecialty care they have come to depend upon," wrote Senator Menendez and Lautenberg. "Accordingly, we strongly urge you to reassure us, as well as parents and children in New Jersey, that Horizon will continue to negotiate vigorously and in good faith in order to reach a contract with CHOP. The children of New Jersey deserve no less."

The senators also urged Horizon, if it is unable to come to a new contract agreement with CHOP, to provide accurate information about patients' "right to access CHOP in New Jersey and Pennsylvania, including any limitations, increased deductibles and co-pays." Parents have reported receiving confusing information about their access to CHOP since the contract was canceled.

Many New Jersey families, especially in Southern New Jersey, rely on CHOP for specialized pediatric care. CHOP serves 45,000 patients from NJ, including 30,325 patients covered by Horizon. In fact, approximately one quarter of children admitted at CHOP's Main Campus in Philadelphia come from New Jersey.

CHOP's healthcare network includes Specialty Care Centers, Ambulatory Surgery Centers, Kids First Pediatric and Adolescent Practices, Home Care and pediatric services in community hospitals throughout New Jersey. Specifically:

- Kids First Practices located in Cape May County, Mt. Laurel, Salem Road in Burlington Township, Smithville and Somers Point;
- Specialty Care Centers in Mays Landing-Atlantic County, Princeton, Voorhees, and the Pediatric Cardiology Division at Saint Peter's University Hospital;
- The CHOP Connection Program at Shore Memorial Hospital in Somers Point;
- The Children's Intensive Emotional and Behavioral Program located at the Specialty Care Center in Mays Landing-Atlantic County.

PDF of letter

Text of letter:

October 31, 2008

Mr. William J. Marino, President and Chief Executive Officer
Horizon Blue Cross Blue Shield of New Jersey
Three Penn Plaza East
Newark, New Jersey 07105-2200

Dear Mr. Marino:

It has come to our attention that Horizon Blue Cross Blue Shield of New Jersey ("Horizon") has terminated its contract with The Children's Hospital of Philadelphia ("CHOP"). We are very concerned about this termination since a number of children living in New Jersey may lose the access to pediatric subspecialty care they have come to depend upon.

Accordingly, we strongly urge you to reassure us, as well as parents and children in New Jersey, that Horizon will continue to negotiate vigorously and in good faith in order to reach a contract with CHOP. The children of New Jersey deserve no less.

If for some reason, however, a contract with CHOP cannot be entered into promptly, then Horizon must ensure that the public receive accurate information about their right to access CHOP in New Jersey and Pennsylvania, including any limitations, increased deductibles and co-pays. It is our understanding that some of the information provided by Horizon has been confusing and, at times, incomplete regarding these issues.

We look forward to hearing from you directly so that we may learn more about your intentions to negotiate a resolution to this matter, as well as to hear more about how Horizon intends to provide full and accurate information to families about the implications of this termination.

Sincerely,

Senators Menendez and Lautenberg
http://lautenberg.senate.gov
http://menendez.senate.gov