Why is Horizon making it harder for patients to get 5-Star Healthcare in New Jersey?

In 2015, Horizon Blue Cross Blue Shield of New Jersey launched the controversial OMNIA plan, forcing many consumers to either switch providers or pay more to be treated by their trusted doctors and hospitals. Since that time, Horizon has come under fire by elected officials, legislators and health care experts alike. And a lawsuit brought by a coalition of community hospitals means Horizon will have to defend its ill-conceived plan in court this spring.

Now, Horizon is introducing a new Medicare Advantage plan that would employ a similar restrictive network of hospitals and physicians, based on the flawed OMNIA scheme. New Jersey’s state senators are calling foul and asking Horizon executives to testify and provide answers.

Horizon’s OMNIA scheme dangerously undermines health care delivery in New Jersey by steering patients to large chain hospitals and making it more difficult to get treatment at some of the state's best hospitals — including Holy Name Medical Center, the only CMS 5-star hospital in Northeast New Jersey.

And now with its flawed Medicare Advantage plan, Horizon’s continued manipulation of the healthcare market will have serious consequences for New Jersey hospitals, physicians, and consumers.

Horizon's controversial OMNIA scheme hurts consumers!

“If I want to send patients to people I trust and work with and they are not in Tier 1 - and it has nothing to do with quality - that’s a problem. It has created a rift.” — Dr. John Poole

• Horizon’s OMNIA and Medicare Advantage Plans exclude many of the state’s highest-ranking hospitals based on quality, safety and affordability metrics. In fact, Horizon even excluded Holy Name Medical Center, the only CMS 5-star rated hospital in Northeast New Jersey!
• Many patients have been forced to find a new doctor or hospital - even in the middle of treatment - or pay a much higher copay.
• The exclusion of so many doctors and hospitals creates a critical health care gap for patients and families in many at-risk communities.

Horizon opposes transparency. What are they hiding?

“This is a fairly consequential, broad public impact matter.” — Superior Court Judge Robert Contillo

• Despite demands from elected officials and the media, Horizon still refuses to divulge its mysterious selection process and has gone to great lengths to keep this information secret.
• There was no public process or known criteria by which hospitals and physicians were assigned to a tier, nor is there any public path to move to another tier.
• The New Jersey Supreme Court has ruled that Horizon must turn over important information regarding its selection process for Tier 1 providers.

Now, the New Jersey State Senate is calling on Horizon executives to explain their controversial OMNIA plan once again.

We need to control health care costs. But we also have to make sure that insurance companies aren’t profiteering at the same time.” — Senate President Steve Sweeney - WBGO Radio, December 22, 2017

• Saying that members of the Senate continue to receive frequent inquiries from constituents about these products, Senate President Steve Sweeney called on Horizon executives to once again appear before the state Senate to explain their selection criteria for Tier 1 providers.
• New information uncovered by the New Jersey Supreme Court shows Horizon's October 5, 2015, testimony and letter to the Senate was incomplete, omitting key information, and misleading.
• With the introduction of the Medicare Advantage plan, lawmakers are concerned about the impact Horizon’s continued market manipulation will have on the consumers in their districts.

Call your state legislator today!
Tell them to Say No to Horizon’s Flawed OMNIA Scheme!

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