New Jersey’s interim insurance commissioner denied a medical group’s request to halt the state’s largest health plan’s effort to limit benefits at out-of network surgical centers.

Neil Jasey

The ruling by Neil Jasey – his first official act as acting commissioner – means Horizon Blue Cross Blue Shield of New Jersey can go forward with its plan changes.

In an order issued July 23, Jasey denied the request made by The Alliance for Quality Care, a coalition of healthcare providers, including ambulatory surgery centers (ASCs), pain management and orthopedic surgery communities. The Maplewood, N.J.-based group works on various “challenges” facing the provider community, according to its website.

Marshall McKnight, a spokesman for the New Jersey Department of Banking and Insurance, said that the state’s Appellate Division upheld Jasey’s decision.

In June, Horizon submitted three decreasing benefit riders for its Horizon Direct Access Small Employer Health Plans to the New Jersey Department of Banking and Insurance that, among other things, limited benefits for non-network ASCs to $2,000 per covered person. The riders also limited benefits for durable medical equipment to $2,500 and limited home health care to 60 annual visits per covered person. The department approved the riders on June 12 to take effect Aug. 1.

A month after the approval, the alliance filed an emergency request to delay implementation of the department’s decision and refer the riders to the state’s office of administrative law to determine the lawfulness of the approval before Horizon begins selling the plans.

In its request, the alliance said its members would be affected by the riders and argued that the $2,000 cap on ASC benefits was “contrary to law because it limits benefits below those set forth in the standard [small employer health] plans,” as it was not in the “reasonable and customary” range defined by state law. Therefore, the group claimed, the department’s approval was “flawed,” according to a copy of the order.

Horizon countered that the alliance’s opposition to the move was “frivolous.”

In his order, Jasey found that the alliance, as a third party in the matter, has no right to contest the department’s decision. Jasey also denied the alliance’s request to delay the sale of the plans as unlawful under state law, finding that the alliance “provided no evidentiary basis that would support such a request.”