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[UPDATED] Hospital groups file new motion against Horizon over Medicare plan; Horizon fires back

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CentraState Medical Center is one of three hospitals suing Horizon BCBSNJ over new Medicare plan
CentraState Medical Center is one of three hospitals suing Horizon BCBSNJ over new Medicare plan - ()

A group of three large hospital systems have filed a motion in Chancery Court in its ongoing lawsuit against Horizon Blue Cross Blue Shield of New Jersey.

The new motion is regarding the introduction of the Horizon Medicare Blue Advantage Plan. Specifically, CentraState Medical Center, Holy Name Medical Center and The Valley Hospital contend that the new plan breaches their contract with Horizon by excluding them from the tier 1 portion of the plan.

“[The new plan] breaches their contracts with Horizon and other legal rights because it excludes them from participation in this by limiting coverage to a narrow network of select hospitals that are almost exclusively the largest systems in the state and a few hospitals affiliated with them,” according to a written statement from CentraState Medical.

The system also states that the new Medicare plan will force senior citizens to find new physicians and hospitals because they will no longer be covered, and “possible travel great distances to seek care, or pay all of their medical bills themselves.”

Horizon, in an e-mail response, dismissed the accusations.

“As Washington threatens the healthcare of millions, it is disappointing that a handful of New Jersey hospitals are trying to prevent Horizon from giving senior citizens who rely on Medicare more choices for quality, affordable health insurance. Their scare tactics are particularly questionable given that these very hospitals have, for years, been part of the same kind of Medicare Advantage networks with Horizon’s for-profit competitors. Horizon will continue to put New Jerseyans who need high quality, affordable health insurance first, especially our seniors, while these hospitals spend millions on attorneys and public relations firms to protect their profits.”  

The motion is being added on to a lawsuit that the three hospital systems filed last year over Horizon’s OMNIA Health Alliance and related tiered health insurance plans. Tier 1 of the OMNIA health plan ensures lower or no copays for consumers, and health systems have said that, in order to participate, they had to agree to lower rates. Tier 2 providers are considered in-network but their patients don’t benefit from lower copays.

The OMNIA alliance includes seven large hospitals and health systems in the state, as well as the state’s largest physician group, Summit Medical Group.

Horizon filed a motion to dismiss the case last April, but was denied. Four out of the seven plaintiffs dismissed their complaints and withdrew from the suit afterwards.

To avoid delaying the trial in case over the OMNIA Health Alliance plans, scheduled for March 2018, the hospitals have asked the court for permission to file these claims at a later time in a separate suit.

National law firm Day Pitney is representing the three hospital systems.

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Vince Calio

Vince Calio


Vince Calio covers health care and manufacturing for NJBIZ. You can contact him at vcalio@njbiz.com.

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