New Jersey's acting Attorney General has determined Horizon Blue Cross Blue Shield of New Jersey's OMNIA line of discount health plans did not violate any laws, according to NJ.com.
Acting Attorney General Robert Lougy's decision, detailed in a letter released Friday, comes five months after state Sens. Nia Gill (D-Essex) and Joseph Vitale (D-Middlesex), requested he "delay Horizon from offering the OMNIA tiered plans" until his office established "a permanent oversight mechanism for the process for tiering and rating healthcare providers in New Jersey," according to the report.
Blue Cross Blue Shield of New Jersey, the state's largest insurer, has been on the defense since announcing the launch of its OMNIA tiered health plans early last fall. The line is designed to offer consumers significant savings if they agree to seek care from hospitals chosen for the network that agreed to lower reimbursement rates.
Hospitals in the network have been assigned to either a Tier 1 or Tier 2 category. Tier 2 hospitals are worried too many of their privately insured patients will migrate to the top tier hospitals, further straining their finances. In November, 17 hospitals named to OMNIA's Tier 2 category filed an appeal challenging Gov. Chris Christie's (R) administration's approval of the health plan.
In the fall, acting Attorney General Lougy said he would review the transcript and any related documents from an Oct. 5 hearing, where Horizon and state insurance regulators who approved the insurance plan were questioned on how OMNIA was created and the criteria used to determine the tiers of hospitals.
In his letter to Sens. Gill and Vitale, acting Attorney General Lougy said: "At the request of members of the Legislature, the Attorney General has undertaken a careful review into the OMNIA Health Alliance established by Horizon Blue Cross Blue Shield of New Jersey to determine if the implementation or operation of the Alliance violates New Jersey law. The Attorney General has determined that no further action is warranted as a result of that review," according to the report.
Regarding the letter, Sen. Vitale said, "I appreciate the letter but it was not what we asked the Attorney General to do. We wanted an ongoing role — a level of oversight by those independent eyes and ears for healthcare consumers because I did not believe the Department of Banking and Insurance did its job. We could not allow Horizon to decide state health policy and which hospital succeeds and which suffer."