Horizon Blue Cross Blue Shield of New Jersey Coverage Update

South Jersey Radiology Associates (SJRA) and Larchmont Medical Imaging are committed to restore our in-network status with Horizon Blue Cross Blue Shield of NJ health plans. We appreciate your understanding as we navigate this difficult situation with Horizon Blue Cross Blue Shield of New Jersey (Horizon). See below for additional information regarding the latest changes and how this arose, and what you can do to help regain your access to our high quality, cost-effective care.

Despite being a premier provider of radiology services for over 50 years as the region's first Diagnostic Imaging Center of Excellence designation and the only non-hospital Comprehensive Breast Imaging Center designation in the area, SJRA and Larchmont have not received a rate increase from Horizon in 7 and 5 years, respectively.

Imagine you are an employee who has been working at a company for decades. All your performance reviews are very positive, and you are clearly one of the best employees in the company. Despite your strong performance, and while your company continues to bring in increased profits year after year, you have not had a pay raise in seven years. Your expenses continue to increase through inflation, and you realize that you must approach your employer about a raise to keep up with your cost of living. You finally summon the courage to ask for this raise, and instead of listening and engaging in a discussion, your employer responds that you need to take a pay decrease to remain at the company.

How would you feel in this situation? What would you do?

Sadly, this is the situation we found ourselves in with Horizon. When we approached Horizon to engage in discussions about finding a new rate that would reflect the significant increase in our costs of providing high quality care, they actually responded with a proposal that would be a significant rate decrease. Since our rates with Horizon are already the lowest among any of the other major commercial insurance companies, a significant rate decrease would make it unaffordable for us to continue to provide the quality of care you expect from our practices. Thus, we find ourselves out-of-network with Horizon. Unfortunately, other healthcare providers in our area may soon find themselves in a similar position.

This decision was not made easily. We were concerned how an out of network status with Horizon would impact our patients and residents of southern New Jersey. And, unfortunately, Horizon's recent communication to members about "alternatives" to our services omitted important considerations for patients.

Many listed alternative imaging sites were hospital-based imaging, which can be 4-6 times more expensive than our services. Also, other listed alternative imaging sites do not provide the full range of imaging services. For instance, few of the non-hospital locations offer mammography or diagnostic breast services, and one location only provides X-rays. Plus, it may take 3-4 weeks to get an imaging appointment at the listed alternative imaging sites and obtaining results adding up to a week to that timeframe.

We’ve heard from many patients expressing frustration over this situation. We are frustrated too and are working hard to advocate for you. We deeply appreciate the outpouring of support from our patients, which underscores the importance of the care we provide. If you share our concerns and want to stand up for fair treatment of providers like us, please go to our website to find ways to voice your desire to regain in-network access to our radiology services with the New Jersey Department of Banking and Insurance and directly with Horizon.

We are committed to advocating for you and remain hopeful that Horizon will reconsider its position. Together, we can ensure that healthcare remains fair, accessible, and of the highest quality for our community.

We sincerely appreciate the huge number of emails and social media posts we've seen in support of SJRA and Larchmont. It means the world to use that you feel so strongly about the care we provide. If you'd like to continue to support regaining network access to our services, there are a few actions you can take to share the impact of Horizon's position is having on your personal situation:

1. Call the New Jersey Department of Banking and Insurance at 1 (800) 446-7467. This is the organization that provides oversight and management for health insurance in New Jersey. Let them know what having access to care at SJRA and Larchmont means to you.



2. Call Horizon to tell them your story at 1 (800) 355-2583. When you do, pay attention to how long you wait on hold, how helpful they are getting you to a decision maker within their organization, and whether they seem to care about your personal health situation.



3. Share your story on Horizon's social media. Share the impact not having access to SJRA and Larchmont's care is having on you and your family. And if Horizon's negotiating tactics are impacting your access to other local providers, share that as well.

In the meantime, we will continue to advocate for you. We remain hopeful that Horizon will change its position so we can continue to provide you with the high-quality care you and our community deserve.