The Bayonne Medical Center has filed a federal lawsuit against Horizon Blue Cross Blue Shield of New Jersey making several allegations against the insurer, including intimating patients not to access emergency care at the hospital and “indefensible” denial of claims.

The Bayonne, N.J., hospital filed suit in the U.S. District Court in Newark, N.J., July 21, more than two months after Horizon sued it in state court for allegedly terminating its network agreement and charging exorbitant fees and misrepresenting its fees for services.

BMC’s suit seeks to halt “Horizon’s illegal, fraudulent, egregious and unethical business practices” which it says is endangering lives and threatening the hospital’s financial viability, “all in the name of boosting its own bottom line and prospects for an initial public offering.”

Horizon announced its intent to become a for-profit entity a year ago, a request under review by the New Jersey Department of Banking and Insurance and the state’s attorney general’s office.

Among the allegations against the insurer, outlined in the 76-page suit, are a “systematic campaign” of intimidating patients into abandoning emergency care at BMC already underway, including calls to patients and visits by couriers instructing them to seek treatment at an “in-network” hospital. BMC also alleges “egregious and arbitrary” denials of coverage and claims for emergency care, including care already underway, and “constant efforts to under-compensate the only emergency care option in the Bayonne community.”

Daniel Kane, CEO of the medical center, said, “Horizon’s attacks are not on hospitals but on the communities they serve.”

“Their relentless assault on patients, doctors and hospitals for the sake of their own profits is a prime reason that New Jersey ranks last in the country for emergency rooms per capita,” Kane said in a statement. “Neither this hospital nor the people of Bayonne will be bullied by Horizon. BHC filed this case to fight for patients’ rights for quality health care and hopes that other hospitals will do the same in their conflicts with Horizon.”

In a statement to IFAwebnews.com, Horizon denied the allegations in the lawsuit and has not participated in any of the alleged improper actions. Horizon officials referred a reporter to their recent allegations filed against BMC.

“The root cause of this dispute is money – Bayonne wants to increase its revenues on the backs of Horizon BCBSNJ members,” according to the insurer’s statement. “In addition to recent labor contract disputes and leaving the hospital networks of most major health insurers, Bayonne has been charging exorbitant fees and misrepresenting its fees for those services.”

Joining Horizon as a plaintiff in the federal lawsuit is Dr. John Godinsky of Bayonne, a Horizon customer admitted to the hospital’s emergency room for an irregular and rapid heart rhythm April 30. According to the suit, while still at Bayonne Medical Center, Horizon contacted Godinsky and hospital administrators to inform them the doctor’s stay was being denied due a pre-existing condition, a denial later found improper.

The suit says that against the advice of his attending physicians, Godinsky left the hospital fearing a large bill for his care during his stay.

“Horizon’s practice of ignoring the independent, attending physician’s diagnosis and replacing the attending physician’s hands-on evaluation of the patient’s emergency medical condition with a perfunctory paper review performed by a medical director on the payroll of Horizon, constitutes a fraudulent and illegal practice, which is aimed at increasing Horizon’s profits irrespective of the patient’s health or the threat to the patient’s safety,” the suit claims. “What is almost as reprehensible, is that Horizon represents to the patient that a transfer to another facility is in the patient’s financial interest. This is an outright lie.”