Arguing it was "wrongly excluded" from a line new of discounted insurance plans, Saint Peter's University Hospital sued Friday to stop Horizon Blue Cross Blue Shield of New Jersey from selling the policies without giving the New Brunswick a chance to participate.
TRENTON -- Arguing it was "wrongly excluded" from a line new of discounted insurance plans, Saint Peter's University Hospital Friday sued to stop Horizon Blue Cross Blue Shield of New Jersey from selling the policies without giving the New Brunswick hospital a chance to participate.
The hospital's attorney, Jeffrey Greenbaum, confirmed he filed an injunction in state Superior Court in Middlesex County asking a judge to prevent the state's largest insurance company from selling OMNIA Alliance policies that will offer consumers a 15 percent discount from their other products in 2016.
A hearing is scheduled for Monday morning.
Horizon created the Alliance and a two-tier system that will enable patients to save money if they use 36 "Tier 1" hospitals and about 24,000 medical professionals. St. Peter's was among the 36 other hospitals in the state in the "Tier 2" category that patients may use, but with more out-of-pocket costs.
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Horizon's press office could not be immediately reached for comment.
"We are going to request the OMNIA program be enjoined until Saint Peter's is given a fair opportunity" to apply for tier 1 status, Greenbaum said.
With seven out of eight Catholic hospital systems excluded from OMNIA and Tier 1 status, Horizon is denying affordable people who want faith-based care, Greenbaum said.
Horizon announced the OMNIA Alliance plans in September and described them as offering affordable and high quality care with a focus on preventing illness and managing chronic conditions. Other carriers, such as Aetna, also offered tiered networks to curb costs. But with 3.8 million customers, Horizon wields considerable buying power.
Horizon has stressed that it will continue to offer most of its existing plans - giving consumers a variety of choices, and Tier 2 hospitals and doctors plenty of business.
The excluded hospitals -- many of them Catholic, located in cities or serve many uninsured and Medicaid clients -- say they fear they will fall into economic crisis.
The hospital declined to comment Friday. But in an Oct. 5 legislative hearing discussing the formation and potential impact of the OMNIA Alliance, Saint Peter's Healthcare System CEO Ronald Rak said "this plan deprives the consumer of the ability to seek treatment in a faith-based facility without being penalized financially.
"Do not underestimate the importance to so many Roman Catholics - as well as all Christians; Orthodox and other Jewish brothers and sisters; and men and women of differing faiths or no faith whatsoever - that they receive care in a setting that nurtures compassion and a respect for life at all stages from conception to death," Rak said.
The New Jersey Catholic Conference, an organization that represents the bishops, sent a letter last week asking Horizon CEO Robert Marino to let hospitals apply for Tier 1 status.
"We are disappointed because the Horizon plan will 'steer' patients to preferred Tier 1 hospitals at the expense of Catholic and other hospitals. The end result of the Horizon decisions could be the closure of Catholic hospitals with disastrous impact on the people of our State, especially those who are most vulnerable," the letter said.