Horizon BCBSNJ’s counterclaim to Newton’s lawsuit alleges the following:

• Newton has prevented Horizon BCBSNJ from contacting its members receiving treatment at Newton so they can be informed of less expensive services at competing hospitals within Horizon BCBSNJ’s network of participating hospitals.

• Newton has prevented Horizon BCBSNJ from contacting its members receiving treatment at Newton so they can be advised of their contracted benefits with Horizon BCBSNJ.

• Newton’s attending physicians and employees have engaged in a pattern and practice of blocking Horizon BCBSNJ from determining the medical necessity and appropriateness of care provided by Newton.

• Newton has prevented Horizon BCBSNJ from determining its members’ suitability for transfer from Newton to Horizon BCBSNJ network hospitals by refusing to respond to requests for the medical status of our members receiving treatment at the hospital.

“Newton’s refusal to allow us to speak to our own members suggests that they are concerned with increasing revenue, not doing what’s right for our members,” said Jim Albano, Vice President, Healthcare Services, Horizon BCBSNJ. 

Click here to view a copy of Horizon BCBSNJ’s Answer and Counterclaim filed at the Superior Court of New Jersey Law Division, Sussex County

Horizon BCBSNJ’s lawsuit against Newton Memorial Hospital’s fraudulent billing practices alleges the following:

• Since terminating its contract with Horizon BCBSNJ effective November 23, 2008, Newton has fraudulently billed Horizon BCBSNJ by waiving patients’ financial liability, including coinsurance and deductibles, as well as other costs.  By not collecting these fees from patients, Newton is wrongfully submitting fraudulent and inflated bills to Horizon BCBSNJ.

• By waiving member liability, Newton is driving up health care premiums for all of Horizon BCBSNJ’s 3.6 million members.

"Newton's practices are creating the perception that health care consumers are saving money," noted Albano. “However, the end result is increased health care costs for Horizon Blue Cross Blue Shield of New Jersey members.”  
 
Click here to view a copy of Horizon BCBSNJ’s lawsuit alleging billing fraud by Newton Memorial Hospital.   The suit was filed at the Superior Court of New Jersey Essex County Chancery Divison.

About Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is the oldest and largest health insurer in the state serving over 3.6 million members. Horizon BCBSNJ is New Jersey's only not-for-profit, health services corporation and is headquartered in Newark with offices in Wall, Mt. Laurel, and West Trenton.

Horizon BCBSNJ provides a broad array of health and dental insurance products and services for individuals and small and large companies, including national companies headquartered in New Jersey.  Horizon BCBSNJ is committed to improving the health care experience for all the communities we serve as well as helping our members become and stay healthy.

Horizon BCBSNJ’s Web site is located at www.HorizonBlue.com. Horizon BCBSNJ is an independent licensee of the Blue Cross Blue Shield Association.