A Superior Court judge Thursday declined to force Horizon Blue Cross Blue Shield of New Jersey to include St. Peter's University Hospital in its new discounted insurance policies.
TRENTON -- A Superior Court judge on Thursday declined to force Horizon Blue Cross Blue Shield of New Jersey to include St. Peter's University Hospital in its new discounted insurance policies until a lawsuit between the two is resolved.
The ruling dealt a setback for St. Peter's, which has argued it was wrongfully excluded from the OMNIA Alliance policies that will offer consumers a 15 percent discount from Horizon's other products in 2016. Though Judge Frank Ciuffani in Middlesex County declined to grant the preliminary injunction, he did order an accelerated hearing on the lawsuit.
St. Peter's attorney, Jeffrey Greenbaum, said he's "hopeful that we will prevail and establish that we were wrongfully excluded from Tier 1, and Horizon exercised bad faith in doing so."
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.
7 N.J. hospitals sue Horizon for branding them subpar in ad campaignGreenbaum predicted that expedited hearing could take place as soon as April, still months after Horizon launches the new policies.
"We believe it's causing us ongoing injury, and we will urge the judge to take that into account in the final hearing through damages and mandatory injunctive relief," he said.
Greenbaum has argued that excluding seven out of eight Catholic hospital system from OMNIA and TIER 1 status denies people affordable, faith-based care.
"With time, the truth regarding how how the OMNIA program was conceived, designed and implemented will come out, and we're confident New Jersey's healthcare consumers will demand better," St. Peter's CEO Ronald C. Rak said in a statement.
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.
Spokesman Thomas Vincz said Horizon is pleased "that the court has refused this effort by St. Peter's to change the implementation of Horizon's OMNIA Health Plans.
"This is good news for the thousands of individuals who have purchased OMNIA Health Plans to date. They can rest easy over the holidays knowing their new, lower-cost OMNIA Health Plan coverage will be effective come Jan. 1, 2016."
Samantha Marcus may be reached at smarcus@njadvancemedia.com. Follow her on Twitter @samanthamarcus. Find NJ.com Politics on Facebook.
