CarePoint sues Horizon for $76M in unpaid, underpaid medical bills

Jersey City, N.J.-based CarePoint Health has filed a federal lawsuit against Horizon Blue Cross Blue Shield of New Jersey, alleging the payer owes CarePoint $76 million in unpaid and underpaid claims.

In the complaint filed Monday, CarePoint's three hospitals — Bayonne (N.J.) Medical Center, Hoboken (N.J.) University Medical Center and Christ Hospital in Jersey City, N.J. — claim Horizon has an "intentional and unlawful pattern of drastically underpaying" for care.

Horizon responded to the lawsuit Wednesday by blasting CarePoint for its documented history as one of the most expensive healthcare providers in the state, sometimes charging 20 times what Medicare pays for out-of-network services. In a statement, Horizon said it plans to counter-sue CarePoint to recoup excessive out-of-network payments made to CarePoint hospitals.

CarePoint's three hospitals terminated network contracts with Horizon in June due to reimbursement disagreements. But the hospitals and insurer have since been in mediation to reach a new agreement, Horizon spokesman Kevin McArdle told The Star Ledger.

CarePoint spokesperson Jarrod Bernstein confirmed the mediation talks are ongoing but declined The Star Ledger's request for comment.

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