The Washington Post story, dated October 9, 2009, regarding the dispute between Horizon Blue Cross Blue Shield of New Jersey and Bayonne Medical Center was inaccurate and misrepresented and omitted a number of critical facts.  The following important facts were provided to The Washington Post reporter, who failed to include them in her story:

• No Horizon BCBSNJ member was transferred out of Bayonne Medical Center after the hospital terminated its contract (February through September);

• Horizon BCBSNJ is required by law to send letters to certain members when a hospital terminates to inform them that they will possibly be subject to higher out-of-pocket expenses by obtaining non-emergent services at an out-of-network hospital;

• Bayonne Medical Center has blocked Horizon BCBSNJ from communicating with its members who are patients at the hospital about how the hospital’s increased charges could affect them in higher out-of-pocket costs and higher premiums;

• After leaving Horizon BCBSNJ’s network, Bayonne Medical Center more than doubled their charges, which on average increased from $13,000 a day to $29,000 a day;

• Horizon BCBSNJ pays Bayonne Medical Center with premium dollars paid by our members, or if employers are self-insured, the employers’ money.  Either way, you end up paying more when hospital’s unreasonably increase their charges;

• Health insurance premiums are a reflection of the underlying cost of care, the biggest component of which is hospital services.  As a result of Bayonne Medical’s unreasonable increase in charges, one City of Bayonne employer’s premiums rose more than 68%!

• Bayonne Medical Center alone decides what it will charge once it goes out of Horizon BCBSNJ’s hospital network.  There are no regulations limiting the amount it can increase its charges and the hospital does not have to publish those charges;

• Bayonne Medical Center publicly advertised that it will not bill patients for their co-payments or deductibles for out-of-network services as dictated under patients’ policies.  Bayonne Medical Center advertised that it would accept whatever amount Horizon BCBSNJ pays them.  Bayonne Medical Center, however, then bills Horizon BCBSNJ at the full amount of their charges even though the hospital advertised and agreed to accept a lower amount of payment for those services.

• Federal courts have determined, under Medicare, hospitals that waive patients’ co-payments and deductibles, as Bayonne Medical is doing, are misrepresenting their costs and violating the law, a practice that increases health care costs.  The Inspector General of the United States Department of Health and Human Services has explained:

“A provider, practitioner or supplier who routinely waives Medicare copayments or deductibles is misstating its actual charge. For example, if a supplier claims that its charge for a piece of equipment is $100, but routinely waives the copayment, the actual charge is $80. Medicare should be paying 80 percent of $80 (or $64), rather than 80 percent of $100 (or $80). As a result of the supplier's misrepresentation, the Medicare program is paying $16 more than it should for this item….

“At first glance, it may appear that routine waiver of copayments and deductibles helps Medicare beneficiaries. By waiving Medicare copayments and deductibles, the provider of services may claim that the beneficiary incurs no costs. In fact, this is not true. Studies have shown that if patients are required to pay even a small portion of their care, they will be better health care consumers, and select items or services because they are medically needed, rather than simply because they are free. Ultimately, if Medicare pays more for an item or service than it should, or if it pays for unnecessary items or services, there are less Medicare funds available to pay for truly needed services.”

• The Washington Post reporter was also given a New Jersey court case that held that a provider who regularly neglects to collect copayments or deductibles commits fraud because "if [the provider] tells the insurance carrier he charges $100 and then collects $80 from the carrier, and by prearrangement, forgoes his patient's copayment he has lied to the carrier."  Until September 23, 2009, Bayonne Medical Center was advertising that it would not collect copayments or deductibles from Horizon BCBSNJ members. 

• After Horizon BCBSNJ filed suit against Bayonne Medical Center, the hospital changed its advertisement.  In the September 23, 2009, edition of the Jersey Journal their new ad read, “Bayonne does not waive patient liability.”

• The Washington Post reporter did not give Horizon BCBSNJ the name of the patient “Lisa” referred to in the story.  Horizon BCBSNJ was unable to confirm any of the allegations that appeared in the article, as we are precluded by law to speak about cases without receiving permission from the person involved.

The Washington Post had all the above-referenced facts and failed to publish any of them in its story.  The reporter claimed to be writing a “policy” piece that would not unfairly portray Horizon BCBSNJ.

So how did The Washington Post readers obtain a better understanding of what was actually going on in this dispute? 

Did readers get a better understanding of how such unreasonable increases in charges by hospitals will affect health insurance premiums?

Where was the voice of the employers that have to pay higher premiums when hospitals unreasonably increase their charges? 

Where was the policy discussion about how out-of-network hospitals charge whatever amount they choose with little or no regulation or any transparency? 

Where was the policy discussion about how such unreasonable increases in health care costs lead to a greater number of people becoming uninsured?

The Washington Post has failed its readers.  Such stories only provide ammunition to those who seek to make insurers the "villains" of our health care system.  Yet, hospitals like Bayonne Medical Center that actually drive health care costs higher by their unreasonable actions are not taken to task. 

So maybe it was a “policy” story for The Washington Post.  Absent crucial facts, the story provides misleading ammunition to discredit health insurers in order to further their preferred health care reform policy.