South Jersey Radiology Associates reaches deal to restore in-network status with state’s largest insurer

South Jersey Radiology Associates has reached an agreement with the state’s largest health insurer after spending months outside of its network. 

SJRA announced the breakthrough with Horizon Blue Cross Blue Shield of New Jersey on social media Wednesday. Though the practice remains out of network, representatives are working with the insurer to finalize a date when it can restore access for Horizon beneficiaries. 

“Our team cannot thank you enough for your support and patience during this time,” South Jersey Radiology Associates said in a Dec. 11 announcement. “The countless emails, phone calls and social media outreach we received were a powerful reminder of the trust you have placed in us at SJRA to provide the highest quality care to our community.”

The practice previously announced “with great disappointment” on March 31 that Horizon was ending its in-network status effective April 1. SJRA shared further insight Sept. 16, noting that it had not received a rate increase from Horizon for seven years. This despite being a “premier provider of radiology services” to the South Jersey community for over half a century. 

“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,” the practice said in September. “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.”

Horizon Blue Cross Blue Shield of New Jersey responded by posting a webpage listing other radiology providers in South Jersey that offer the same or similar services. However, SJRA cautioned patients that many are hospital-based imaging sites charging 4 to 6 times more than outpatient alternatives. 

A May 10 post from SJRA—encouraging patients to phone Horizon about the dispute—has garnered over 200 reactions, 62 comments and 14 shares. 

“Has anyone had success with telling your story to BCBS?” responded Sarah Harshaw Wagner. “I have tried so many times but all they say is there isn’t an option to leave feedback or file a complaint. All they can do is send me a list of in-network providers.”

“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,” SJRA said in the September post. 

South Jersey Radiology Associates is part of the larger US Radiology Specialists. The private equity-supported imaging group acquired both SJRA and Larchmont Imaging Associates (also currently out of network with Horizon) in early 2022. A USRS spokesman could not provide further details about the new agreement late Wednesday. Founded in 1938, SJRA employs around 60 radiologists working across 16 locations and serving 600,000 patients per year. Altogether, Raleigh, North Carolina-based USRS has 175 outpatient centers across 13 states handling 8 million studies annually. 

The agreement comes as radiology practices fight to remain in-network with health plans of choice in their service areas. Since the roll out of the No Surprises Act, commercial insurers have started terminating in-network contracts that involve higher-than-average reimbursement rates (which doesn’t sound like the case here), according to S&P Global Ratings. UnitedHealthcare knocked Southwest Medical Imaging in Arizona out of its network in July where it has remained since.