I've been in some epic battles with insurers, and I know that it can get ugly. But, wow. Sending couriers to instruct patients to leave? Forcing ER docs to discharge patients? That's way over any line I've ever heard of.
Suit Charges Horizon with Systematic Attack on Emergency Care in Quest for Profit
BAYONNE, NJ, JULY 22, 2009—Bayonne Hospital Center (BHC)—the only hospital in the medically underserved working class community of Bayonne, NJ—today announced it has filed a federal lawsuit against Horizon Blue Cross Blue Shield of New Jersey (Horizon) [...]
Horizon’s practices and activities include, among other things: a systematic campaign of intimidating patients into abandoning emergency care at BHC that is already underway, including calls to patients and the sending of couriers to instruct patients to leave the hospital while still in the midst of emergency treatment; egregious and arbitrary denials of coverage and claims for emergency care at BHC; and constant efforts to under-compensate the only emergency care option in the Bayonne community, a hospital just rescued from bankruptcy.
The complaint filed today in the U.S. District Court in Newark, New Jersey provides a detailed account of Horizon’s business practices which run counter to the insurer’s contractual duties to its customers, its obligations under state law and its stated commitment to the interest of public health. Some of the most offensive Horizon practices detailed in the complaint include:
•A systematic campaign discouraging patients from seeking emergency care at BHC despite it being the closest and safest option for urgent care for the residents of Bayonne
•Intimidation of patients by threatening denial of coverage if they seek treatment at BHC
•Interference with care by sending couriers to BHC to tell patients undergoing medically necessary treatments to leave BHC and seek care at a hospital that is "in network"
•Indefensible denial of claims, often while the patient is still undergoing care
•Unilateral determinations by Horizon bureaucrats that emergency room patients are medically stable enough to be discharged to home or transferred to other in-network facilities without consulting the patient's attending physician
And yet Max Baucus and the Blue Dogs will fight tooth and nail to protect their buddies in the insurance industry.