Stop lying about our insurance coverage, Horizon demands in dispute with doctors

New Jersey’s largest insurance company is fighting back against a campaign claiming it will limit treatment from chiropractors and physical therapists by suing the association it says is spreading the lies.
Horizon Blue Cross Blue Shield of New Jersey sent out letters in early August to the thousands of licensed acupuncturists, chiropractors and occupational, physical and speech therapists to alert them to the proposed partnership with American Specialty Health Network, a national review company.
In 2020, patients will continue to qualify for up to 30 visits a year, and they will see no difference for the first five treatment visits in 2020, according to Horizon’s letter. But on the sixth visit, the company may conduct “a medical necessity determination review” and if necessary, ask the medical provider for more information."
The news has alarmed physical medicine practitioners because they contend ASH, here and in other states, has a reputation for denying claims. Trade groups, such as the American Physical Therapy Association of New Jersey and the Association of New Jersey Chiropractors, warned the arrangement would threaten livelihoods and deny patient treatment.
But Horizon took aim in its federal defamation lawsuit Tuesday against the nonprofit Doctor Patient Alliance. In blog posts and emails, the Alliance called the partnership between Horizon and ASH “bad news if you are a patient with Horizon, or if you treat patients insured with Horizon plans, as cutting benefits appears to be the business model of ASH.”
“The Horizon/ASH partnership threatens your benefits!” according to the alliance’s webpage.
Horizon is suing the alliance for interfering with its business plans and for the loss of any business that arises from the misleading, defamatory campaign.
The alliance urged its members to write to the Department of Banking and Insurance to deny the partnership between ASH and Horizon.
“Horizon was prompted to take legal action as a result of a relentless series of internet and e-mail advertisements propounded by the New Jersey Doctor Patient Alliance that at best can be called a smear campaign,” according to the lawsuit.
“As a representative of medical providers, (the alliance) is concerned that Horizon’s proposed partnership with ASH will require them to provide evidence of medical necessity for treatments, thus inhibiting providers’ ability to provide unnecessary treatments and procedures,” the lawsuit said.
ASH’s participation, Horizon’s lawsuit said, “will not impact members’ covered benefits in any way, including: (a) no changes to the number of visits covered by members’ plans; (b) no changes to cost-sharing responsibility for covered in scope services; and (c) members are not required to have services or visits pre-authorized.”
Representatives for the alliance could not be reached for comment.
A nonprofit organization incorporated two years ago, according to state records, the alliance was formed “to help unite patients and their doctors in an effort to create more transparency and education around insurance, medical billing, and affordable healthcare in New Jersey,” its website said. Its board members and officers include orthopedists, surgeons, pain management specialists and chiropractors.
Horizon is the largest insurance carrier in New Jersey, with 3.7 million members.
Susan K. Livio may be reached at slivio@njadvancemedia.com. Follow her on Twitter @SusanKLivio. Find NJ.com Politics on Facebook.

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