DECEMBER 10, 2015, 3:15 PM LAST UPDATED: THURSDAY, DECEMBER 10, 2015, 3:20 PM
BY LINDY WASHBURN
STAFF WRITER |
Holy Name Medical Center in Teaneck and The Valley Hospital in Ridgewood opened a new front in the widening fight against the state’s largest insurer Thursday, with a lawsuit demanding that Horizon Blue Cross Blue Shield of New Jersey halt further advertising of a new, tiered health plan because — by leaving their hospitals out of the preferred tier — it makes them look inferior.
Horizon breached its contract with the hospitals when it announced the new Omnia health plans in September, the lawsuit filed in state Superior Court in Hackensack by the two hospitals and five others said. The insurer was obligated to give the hospitals an opportunity to negotiate participation in the new plans, the suit said.
The Omnia plans, now being advertised widely, group hospitals into two tiers, and will allow patients to pay lower deductibles and co-insurance when they seek care from a preferred, or Tier 1, hospital. The plans are being sold to individuals, small businesses, state government employees and people who buy insurance through the federal Affordable Care Act for coverage starting Jan. 1. Premiums are 12 to 15 percent lower than for other Horizon plans.
“They’re using marketing that is misleading,” said Michael Furey, an attorney with Day Pitney who represents the seven hospital systems suing Horizon, saying that this damages the reputation of his clients. They’re “making the consumer think that somehow the Tier 1 hospitals are superior and the Tier 2 hospitals are inferior,” he said.
Horizon is the largest provider of health insurance in New Jersey, with more than 50 percent of the commercial market. In total, including Medicare, Medicaid, state and federal employee coverage, it provides insurance to 3.8 million people in the state.
In Bergen and Passaic counties, the Tier 1 network includes St. Joseph’s Healthcare System, with hospitals in Wayne and Paterson, and Hackensack University Medical Center and its affiliated hospitals — HackensackUMC at Pascack Valley in Westwood and Englewood Hospital and Medical Center.
Holy Name, Valley, and St. Mary’s General Hospital in Passaic are in Tier 2.