NJ hospital sues Horizon BCBS

New Brunswick, N.J.-based Saint Peter's University Hospital sued Horizon Blue Cross Blue Shield of New Jersey to stop it from selling discounted insurance plans without giving Saint Peter's a chance to participate, according to NJ.com.

In September, Horizon formed the OMINA Alliance, which includes a two-tier system that gives consumers discounted rates. Consumers receive these discounted rates if they use any of the Alliance's 36 "Tier 1" hospitals and 24,000 medical professionals. Patients who use "Tier 2" hospitals — of which Saint Peter's is included — have more out-of-pocket costs.

The hospital argues it was "wrongly excluded" from the new insurance plans. "We are going to request the OMINA program be enjoined until Saint Peter's is given a fair opportunity" to apply for Tier 1 status, said the hospital's attorney, Jeffrey Greenbaum.

Horizon says it will continue to offer many of its existing plans, giving Tier 2 hospitals and physicians plenty of business.

Mr. Greenbaum further alleges Horizon's OMINA Alliance denies affordable healthcare to patients who seek care from faith-based organizations, as seven out of eight Catholic hospital systems are excluded from Tier 1 status. This is not the first allegation of its kind against Horizon. In September, Sister Patricia Codey, president of the state's Catholic HealthCare Partnership, said Horizon "schemed in secret" to intentionally exclude Catholic hospitals from the new plan.

Last week, the New Jersey Catholic Conference, an organization that represents bishops, sent a letter to Horizon CEO Robert Marino asking him to allow more hospitals to 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 letter said. "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."

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