Horizon BCBS Decrease in Reimbursement Rates
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. 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. The current options given to Urgent Care Centers by Horizon are to accept the rate cut or go out of network. Horizon BC/BS insures up to 50% of patients at most Urgent Care Centers. — Anthony R. Ruvo, MD, FACEP, President, NERUCA

