I received a
letter from Horizon Blue Cross and
Blue Shield of New Jersey saying it
terminated its contracts with the University
of Pennsylvania hospitals. Do I need
to find a new physician? |
First, it is important
for you to know that you will continue
to have access to all University of Pennsylvania
health services at the same benefit level
for the next seven months. The notice
of termination does not currently include
physicians that are part of Penn Medicine.
Horizon notified Penn that it plans
to terminate the agreement covering
the health system's hospitals (Hospital
of the University of Pennsylvania,
Penn Presbyterian Medical Center and
Pennsylvania Hospital) effective April
11, 2009. During those seven months,
we will be working with Horizon toward
the goal of reaching an agreement that
is acceptable to both parties. |
I am currently
receiving treatment at a Penn hospital.
What happens if I am still being treated
when the contract expires? |
You may be able to
continue to receive in-network benefits
for your treatment as part of your continuity
of care. Even if you do not qualify for
continuity of care, you may still be
able to receive treatment at a Penn Medicine
hospital with authorization from Horizon,
or at the out-of-network coverage level. |
Why did Horizon
choose to stop covering services at
Penn Medicine? |
Penn and Horizon
have been in discussions concerning renegotiation
of the hospital contracts for the past
several months. We were surprised and
disappointed to receive this unexpected
notice from Horizon that it plans to
terminate our hospital agreements. |
Is this termination
final or is there a possibility that
a new agreement will be reached? |
We believe you should
continue to have access to the world-class
care you have come to expect from Penn
hospitals. Penn is continuing discussions
with Horizon and hopes to reach an agreement
before the termination date. |
What are my health
insurance options if a new agreement
can't be reached between Penn and Horizon? |
You might want to
consider switching your coverage to another
insurer who has an existing agreement
with Penn, or encourage your employer
to offer coverage through one of those
companies. Our hospitals accept a number
of health plans available to New Jersey
residents, including:
|
Will I be notified
whether or not an agreement is reached
between Penn and Horizon Blue Cross
and Blue Shield of New Jersey? |
Yes. We will continue
to provide updates on the status of the
negotiations here on pennhealth.com. |
I have Medicare
as Primary and Horizon as secondary.
Will I be affected by a contract termination
between Horizon and UPHS? |
No. Your primary
insurance is what is considered first
when applying your benefits. Since UPHS
is a Medicare participating health system,
you will continue to have access to UPHS
hospital with Medicare as your primary
insurance. |
Who do I
call for customer service? |
Call Horizon BCBSNJ's
dedicated Member Services Department
at 1-800-664-BLUE (2583) for any
service or claim issue. You can also
call this number to obtain claim forms
or claim submission information. For
your convenience, our Member Services
Department is open Monday through Friday,
8 am to 8 pm., Eastern Standard Time.
|
By late March
of 2009, I will be in a course of treatment
at UPHS. Will my treatment stop on
April 11, 2009? |
No. The care of our
patients is our greatest concern. All
patients in an active course of treatment
as of April 11th will continue to receive
treatment for medically necessary services
until completion of that treatment. UPHS
will advocate that all patients within
a course of treatment extending beyond
April 11, 2009 be given an additional
continuity of care extension under the
terms of the current contract.
Oncology treatments up to 1 year from
the effective date of termination and
post-operative care up to six months
following termination are just a few
examples that would typically qualify
for an extended continuity of care
period. |
I am pregnant
and want to receive my prenatal care
and deliver my baby at a UPHS hospital.
Will I be able to do this since the
contract with Horizon is scheduled
to terminate with UPHS on April 11,
2009 and my expected delivery date
is after that date? |
Yes. You may continue
to receive your prenatal care at UPHS
and deliver your baby at a UPHS hospital. Horizon
members have access to all UPHS hospitals
and providers as usual up until at least
April 11, 2009. Typically, pre-natal,
maternity, and post partum care qualifies
for an extended continuity of coverage
period beyond April 11, 2009 and UPHS
will advocate on our patient's behalf
that they continue to receive care at
an in-network level under the terms of
our current contract. |
Horizon informed
me that after April 11, 2009, I will
continue to have access to UPHS at
an in-network benefit level since I
am part of the Blue Card Program is
this correct? |
Maybe. Access often
will require an authorization or pre-approval
from Horizon.
Horizon may attempt to direct you
to a participating hospital. The termination
issued by Horizon would make UPHS hospitals
non-participating with Horizon. In
order to be covered for services at
UPHS, Horizon must still authorize
your services at UPHS hospitals. You
(the patient) should express this concern
to Horizon. |
How do I know
if I participate with the Blue Care
Program? |
Look on your Horizon
ID card for a "suitcase" logo.
A suitcase logo indicates your plan has
Blue Card access. The suitcase logo is
usually located on the upper right portion
of the ID card. |
I am a NJ State
employee with Horizon NJ Direct 10
(or NJ Direct 15). Will I still have
access to UPHS after the April 11,
2009 termination? |
NJ State employees
covered by Horizon NJ Direct plans participate
with the BlueCard program. |
For New Jersey
and other Physician Practices: |
Horizon has
not issued a notice of termination
for our physician agreements. If
the Hospital termination initiated
by Horizon takes effect, patients
will continue to have access to your
practice and some local NJ Hospitals,
but may not have access
to Penn hospitals (Hospital of the
University of Pennsylvania, Pennsylvania
Hospital, Penn Presbyterian Medical
Center). We will continue to
communicate to you updates regarding
the status of this issue. |
