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Saint Peter's Hospital files new motion in ongoing suit against Horizon

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Saint Peter’s University Hospital has filed a motion to supplement its lawsuit against Horizon Blue Cross Blue Shield of New Jersey, alleging that the health insurer breached its contract with Saint Peter’s by excluding it from its new Medicare Blue Advantage Plan for 2018.

The motion was made in Middlesex County Superior on Nov. 29.

Horizon BCBSNJ’s new Medicare plan is being advertised as a zero premium plan and is sold in only 15 counties including Middlesex, where Saint Peter’s 478-bed hospital is located. The motion is being added on to an ongoing suit by Saint Peter’s against Horizon for excluding it from the Tier 1 portion of its OMNIA tiered network plan in 2015.

A similar lawsuit is being brought against Horizon by CentraState Medical Center, Holy Name Medical Center and The Valley Hospital. Those systems also filed a motion in October in Chancery court. Like Saint Peter’s, their motion expands their ongoing lawsuit against Horizon for allegedly being unfairly excluded from the same Medicare Blue Advantage Plan.

Horizon’s OMNIA tiered network plan divides hospitals in the state into two categories: Tier 1 and Tier 2. Tier 1 offers lower co-pay and premium rates to customers and includes hospitals that are part of the state's largest health systems. Tier 2 includes many independent, urban or safety net hospitals and offers regular in-network rates to consumers. In creating the plan, Horizon – the largest health insurer in the state – shifts patient volumes away from the Tier 2 hospitals, according to some hospital officials.

Saint Peter’s alleges that being excluded from the Tier 1 portion of the Omnia plan was unlawful in that its contract with Horizon guarantees that Horizon “will provide incentives for patients to use Saint Peter’s as a network hospital, and further guarantees that Saint Peter’s “shall participate” in any new networks or products provided it meets established criteria.”

In its new supplement, Saint Peter’s alleges that the only criteria that Horizon used to exclude it from the Medicare Plan is that it is excluded from the Tier 1 portion of its Omnia plan.

Horizon, in a written statement, was dismissive of the allegations.

“It is unfortunate that St. Peter’s is fighting to prevent seniors from having access to more affordable Medicare options given all that is going on in Washington,” according to the insurer’s statement. “Horizon will continue to stand with New Jerseyans, especially seniors, in demanding more affordable health care. The millions St. Peter’s has spent on this 2-year-old, unsuccessful lawsuit for attorneys and public relations firms have done nothing to lower healthcare costs, which should be everyone’s priority.” 

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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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