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Holy Name Medical Center, Valley Hospital sue to block ads for new tiered Horizon insurance plan


DECEMBER 10, 2015, 3:15 PM    LAST UPDATED: THURSDAY, DECEMBER 10, 2015, 3:20 PM

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.

7 thoughts on “Holy Name Medical Center, Valley Hospital sue to block ads for new tiered Horizon insurance plan

  1. Money makes strange bedfellows.

  2. when someone tells Valley something they don’t want to hear… SUE

  3. Let’s see… legal fees for blocking Pascack, legal fees for the “renewal”, now legal fees to head off advertising… then the real estate acquisition spree… pretty big war chest for a “non-profit”….

  4. Some years ago when Marvin complained to Valley Hospital because their employee prescription plan no longer included Harding Pharmacy – their were very unsympathetic and not even a phone call to advocate on his behalf. It was business. Feels different for Valley when the shoe is on the other foot.

  5. That is very interesting, 11:08. Valley’s management should take a hike. The sole focus and goal of a nonprofit is not supposed to be dollars. The money they have paid those dreadful lawyers should have gone to Ridgewood.

  6. Where’s Mr. Halaby in this discussion ?

  7. and from the linked article ‘….co-counsel for the Tier 2 hospitals. “No transparency about the criteria they used, no transparency about how any hospital selected or not selected was scored, no transparency about how a consumer can access the data that helps them understand these plans.” ‘

    Transparency? This from an industry whose pricing is opaque.

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