b'NEW JERSEYPUBLICATION OF THE ASSOCIATION OF NEW JERSEY CHIROPRACTORS FALL 2019IVOL. 15INO. 4Horizon-ASH Pairing Prompts Unprecedented Action by ANJC, Members and PatientsThe dog days of summer certainly turned up the heat for theSince then, several members and the ANJC have received chiropractic profession in the Garden State this year whencease and desist letters from Horizon. The ANJC also news of a Horizon-ASH pairing emerged. contacted the states three largest newspapers and online On Aug. 1st, the ANJC notified members in a statewidenews services, and all of them wrote articles that ran in both conference call that Horizon Blue Cross Blue Shield ofprint and online editions. The articles can be found on www.New Jersey had entered into an agreement with Americananjc.info under News.Specialty Health Networks (ASH) to provide network managedANJC leadership has been in touch with the other care. Members expressed to the ANJC that they were greatlyprofessional organizations affected as well, including the New alarmed and concerned that ASH reviews of claims wouldJersey Doctor-Patient Alliance (NJDPA), which has organized interfere with their patients best course of care. its own email campaign. And in the latest development, In our opinion, ASH has a history of denying care, improperlyduring the last week of August, the ANJC was notified that paying claims, and creating roadblocks to conservativeASH had filed a lawsuit against the ANJC as well as the care, said ANJC Executive Director Amy Boright Porchetta.NJDPA, citing false advertising, defamation under state We have seen this in a 2012 Market Study conducted bylaw, product disparagement and tortious interference with our very own Department of Banking and Insurance whereprospective economic advantage. ASH was found to improperly pay claims, having an errorASH also requested a temporary restraining order as well as rate of 55-56%, among other issues. DOBI investigatorsexpedited discovery; which was denied by the judge.concluded that ASHs actions constituted a business practice that violated the Unfair Claim Settlement Procedures Act inThe BackgroundNew Jersey. Our members also have provided the ANJC withWhile Horizon and ASH have signed a contract whereby ASH, numerous examples of this continuing unabated since 2012. beginning Jan. 1, 2020, would be responsible for all aspects On Aug. 2nd, the ANJC set up a user-friendly email campaignof provider network management for physical medicine and mobilized members. Members, in turn, rallied theirservices including acupuncture, chiropractic, occupational patients to join the campaign, which populated the senderstherapy and physical therapy, DOBI must approve the state representatives, based on their address, as well ascontract. DOBI has 60 days from the time it was notified to Gov. Phil Murphy. As of press time an onslaught of 192,000reach a decision. emails had been sent. Reactions from legislators were mixed,Horizon says ASH management would be applied to fully and some agreeing to simply monitor the situation while othersself-funded plans including Advantage EPO, Direct Access, implored the commissioner of the DOBI to refuse to authorizeEPO, Federal Employee Program, HMO, Indemnity, Medicare the contract between Horizon and ASH. Advantage, OMNIA Health plans, PPO, POS and all self-At the same time, the association and members posted oninsured Administrative Services Only (ASO) employer groups. social media to educate the public on what ASH managementThe only exclusions to the ASH management will be the could mean for patients based on class action lawsuits filedHorizon NJ Health plans (Medicaid), Medicare Supplemental across the country and a recent $11.75 million settlement of(Medigap plans) and Horizon NJ TotalCare (HMO SNP). a lawsuit in which two New Jersey DCs were lead plaintiffs.[ HORIZON-ASH CONTINUED ON PAGE 4 ]1-800-LAW-2000 www.dsslaw.comNew Jersey andpractice strategies New York Injury Lawyers'