A New Jersey appeals court ruled Thursday Horizon Blue Cross Blue Shield will not have to share how it classified hospitals in its OMNIA Health Plans, which elevates certain hospitals into preferred groups over others, The Record reported.
In a 42-page decision, a panel of three judges overturned lower court rulings in Bergen and Middlesex counties, stating released information about the criteria used to rank hospitals would give competing facilities "tremendous and unprecedented advantage" in future negotiations with insurers like Horizon, Judge Michael J. Haas said in a written decision.
Horizon, the state's largest insurer, announced its OMNIA health plan last October, which tiers providers based on the amount of out-of-pocket costs patients shoulder, with "Tier 1" providers charging the lowest out-of-pocket costs and co-payments.
In November, 11 health systems consisting of 17 hospitals ranked as "Tier 2" appealed the OMNIA plan on grounds a large number of their privately insured patients would migrate to higher tiered hospitals. However, in March New Jersey's acting Attorney General ruled Horizon did not act unlawfully.
The Appellate Court's most recent decision is an answer to two lawsuits, one filed in Bergen County by Holy Name Medical Center in Teaneck, the Valley Hospital in Ridgewood and five other New Jersey hospital groups alleging the insurer breached its contract by withholding its ranking criteria. The other lawsuit was filed in Middlesex County by St. Peter's University Hospital in New Brunswick, which made similar claims.
Robert Marino, chairman and CEO of Horizon BCBS of New Jersey, told The Record the court's decision was "a win for the consumers of New Jersey" and "we should all be working together to address the cost-crisis in healthcare."
However, Steven Goldman, an attorney representing 17 Tier 2 hospitals opposed to Horizon and its OMNIA health plan, said he will appeal the court's decision to the state Supreme Court.
"This case isn't over," Michael Maron, Holy Name's president and CEO, told The Record. "This was a little detour about what has to be revealed in court."