Two groups representing New Jersey ambulatory surgery centers have failed to stop Horizon Blue Cross Blue Shield of New Jersey from selling a new small business health plan that caps payment for out-of-network ASC services at $2,000 per person per year.
The Alliance for Quality Care and the New Jersey Association of Ambulatory Surgery Centers say the Horizon Advantage Direct Access health insurance plan reduces out-of-network ASC reimbursements below the minimum level required by New Jersey state law. The state commissioner of the Department of Banking and Insurance, the state Appellate Division and the New Jersey Supreme Court all denied the groups’ requests to prohibit Horizon from marketing its plan while they mount a legal challenge to it.
"It remains our position that this plan violates the laws governing small employer health benefit plans in New Jersey," says health law attorney Mark Manigan of Brach Eichler LLC, which is representing the two ASC groups. He says they will continue "litigating this case vigorously" in the appellate division, even though Horizon has been authorized to begin selling the plan as of Aug. 1.
—Irene Tsikitas
