Horizon BCBS Decrease in Reimbursement Rates

November 09, 2021 11:42 AM | Administrative Director (Administrator)

To Whom it May Concern,

An important issue has impacted the State of NJ Urgent Care Community. In Sept/Oct 2021 Horizon BS/BC of NJ sent out a letter to all Urgent Care Centers unilaterally changing their reimbursement structure for those centers that were globally reimbursed.  It will be effective January 1, 2022 for those who have agreed to and signed an amendment by Nov. 1st, 2022. No input was sought by the Urgent Care Industry and how this was going to impact on the viability of these centers.

The new reimbursement was based on a 3 tier process. Tier 1 pays 40% of the global rate, Tier 2 pays 80% of the global rate and Tier 3 pays 100% of the global rate.  This impending unilateral rate cut up to 60% will have a significant impact on all Urgent Care Centers, potentially forcing the closure of some centers in the state.  This appears unfair to have been implemented without participating groups input on the effect of this new reimbursement program. The notification period was very brief in that the industry had 30 to 60 days to sign.

The current options given to Urgent Care Centers by Horizon are accept the rate cut or go out of network.  Horizon BC/BS insures up to 50% of patients at most Urgent Care Centers.

We are an organization that has filled a very significant void during the 4 stages of this Covid-19 Pandemic.  We have adapted to and operated under: 1) a declared State of Emergency, 2) Executive Orders from our Governors, and 3) changing guidelines from the CDC, State DOH and OSHA.

While many private practices and clinics closed, the Urgent Care Centers remained open.  When patients refused to go to Hospital Emergency Departments because of fear of contracting Covid-19, (ED volumes dropped by 50%) the Urgent Care Centers expanded staffing and hours to absorb the additional volume which is some cases exceeded a 300+% surge. Now with the addition of community mandates, the coming Flu season and current increase of RSV infections these will further confuse the public concerns.  We are here to provide the answers.

The Urgent Care Centers have provided Community and State support at a significant expense. The impact of a major BC/BS plan enacting these cuts also raises concern for other states.  Please watch UCA Access for future communications regarding this important issue.

Sincerely,

Anthony R. Ruvo, MD FACEP

President, NERUCA

Member Board of Directors, NERUCA


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