An arrangement between a for-profit medical center and the state’s largest insurer is bringing cheer to the Hoboken hospital authority that is looking for a new hospital operator in the Mile Square City.
For-profit Bayonne Medical Center, which has sparked controversy and litigation in recent years for refusing to negotiate rates with most insurance companies, announced Friday it “has resolved all outstanding issues with Horizon Blue Cross Blue Shield.” Bayonne said as of Oct. 1, the hospital will be considered in-network for all services for Horizon subscribers.
The owners of Bayonne have agreed to acquire Hoboken University Medical Center from the city of Hoboken, and the deal is waiting a decision by the state Department of Health. Bayonne’s out-of-network status often was raised by opponents as a reason the state should reject the deal; on Thursday, Spencer Baretz, a spokesman for the Bayonne group, HUMC Holdco, said Hoboken will remain in the Horizon network if the deal is approved.
“It is great news for patients to have HUMC continue as an in-network provider with Horizon,” said Toni Tomarazzo, chair of the Hoboken Municipal Hospital Authority. “This is one of the many issues for which HMHA has diligently advocated in the pending sale of HUMC to ensure the continuation of hospital services and maintain the long-term viability of the hospital. HMHA remains committed to finalizing the sale to Holdco.”
When it approved the sale to the Bayonne group, the Hoboken hospital authority made it a condition that the Bayonne group negotiate in good faith with the state’s health insurers.
Annette Catino, CEO of the managed health care company QualCare, said she hopes the Horizon-Bayonne deal “is a sign that Bayonne is willing to enter into competitive contracts with other payers in New Jersey.”
She said Bayonne is not in the QualCare network, which serves employers that provide self-insured medical plans. QualCare members who have out-of-network benefits use Bayonne, and Catino said Bayonne’s rates are significantly higher than those charged by in-network hospitals. Catino said QualCare negotiates its out-of-network payments to Bayonne, which she said have been settled for less than the hospital’s rates.
Because Bayonne is not in the QualCare network, Catino said QualCare steers its members away from Bayonne, “and we move patients that go in through the ER out as fast as possible.” Still, she added, “we would like to work with them. They serve an important community where we have members.”
“This agreement is a result of our ongoing, good-faith negotiations with Horizon, and will allow us to continue providing the highest quality care for our patients,” said Daniel Kane, CEO of Bayonne Medical Center, in announcing the deal. A Horizon Blue Cross spokesman also confirmed the deal.
In a statement, Bayonne cited improvements it has implemented across the hospital: completion of a new cardiac and vascular interventional unit, installation of a PET/CT scanner, the use of electronic medical records and a family health center. Bayonne said it has restructured its emergency department, which now has an average patient wait time of less than 30 minutes.