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- CAP Opposes Horizon Managed Care Network Denial of Claims for Pathology Services
The CAP has strongly opposed a policy change by the health insurer Horizon of New Jersey to deny payment for certain pathology services. Earlier this year, Horizon proposed revisions to its administrative policy that changed how it would “process certain claims submitted by hospital-based pathologists for services provided to members enrolled in plans/products that use the Horizon Managed Care Network.” The policy went into effect on July 1. After a review of the policy, the CAP sent a letter on November 14 [T(1] to Horizon seeking clarification on the intent behind this policy update and expressing opposition to actions that add patient burdens, disrupt coordination, or compromise quality of care. The concern from the CAP is insurers’ increasing use of restrictive reimbursement requirements and/or reliance on narrow/inadequate networks, which adds unnecessary burdens to receiving laboratory testing and can interrupt continuity of care, exacerbate issues around social determinates of health, and translate to increased costs down the road. The CAP has sought a meeting with Horizon to discuss the matter further. The CAP will keep its members updated on any new developments regarding this issue. Link to PDF [T(1]
The CAP has strongly opposed a policy change by the health insurer Horizon of New Jersey to deny payment for certain pathology services.
Earlier this year, Horizon proposed revisions to its administrative policy that changed how it would “process certain claims submitted by hospital-based pathologists for services provided to members enrolled in plans/products that use the Horizon Managed Care Network.” The policy went into effect on July 1. After a review of the policy, the CAP sent a letter on November 14 to Horizon seeking clarification on the intent behind this policy update and expressing opposition to actions that add patient burdens, disrupt coordination, or compromise quality of care. The concern from the CAP is insurers’ increasing use of restrictive reimbursement requirements and/or reliance on narrow/inadequate networks, which adds unnecessary burdens to receiving laboratory testing and can interrupt continuity of care, exacerbate issues around social determinates of health, and translate to increased costs down the road.
The CAP has sought a meeting with Horizon to discuss the matter further. The CAP will keep its members updated on any new developments regarding this issue.