New Jersey Court Backs Approval of Horizon’s Tiered Health Plan

June 9, 2016

A New Jersey appeals court upheld a decision by New Jersey regulators to approve a new alliance formed by the state’s largest health insurer.

The New Jersey Department of Banking and Insurance didn’t break the rules when it approved Horizon Blue Cross Blue Shield’s OMNIA plan, which uses a tiered network and is touted as a money-saving way to cover health care, the appeals court said Tuesday.

“This decision is another win for consumers seeking relief from skyrocketing medical bills,” Horizon spokesman Kevin McArdle said. “Health care costs are a problem for New Jersey employers and patients and while some are content to be part of the problem, Horizon is committed to being part of the solution.”

Hospitals that weren’t part of OMNIA’s top network argued the insurance department didn’t ensure consumers would have access to the network. The appealing hospitals worried the alliance demotes them to Tier 2, and Tier 1 hospitals will likely get more patients because of lower costs.

The three-judge panel ruled regulators acted in accordance with the law and any changes would have to be addressed by state lawmakers.

Steven Goldman, an attorney for the Tier 2 hospitals, said they will weigh their legal options in the coming days.

“While we are deeply disappointed in the outcome, our clients continue to believe that the Department’s decision to approve the plan was arbitrary, capricious and unreasonable, and will have serious consequences for New Jersey patients and providers,” Goldman said.

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