EVER SINCE Horizon Blue Cross and Blue Shield of New Jersey classified state hospitals as Tier 1 and Tier 2 last fall, critics have wondered about the company's criteria for doing so

That apparently will remain unknown after a state appeals court last week denied opponents of the plan access to the details of Horizon reports and other information explaining why it classified the hospitals the way it did when it launched its Omnia health plan.

We understand that as a private company, Horizon is not held to the same disclosure standards as a public agency. At the same time, the Omnia plan has drawn so much criticism from hospitals left out of the Tier 1 grouping, Horizon could benefit from complete transparency. More important so could the public.

Lawsuit: Horizon misled on how it selected N.J. hospitals for top insurance tier

A group of hospitals suing Horizon Blue Cross Blue Shield of New Jersey for excluding them from a new line of discount health plans claims they have proof the insurance giant based its decision not on quality or cost, despite its marketing claims.

Horizon selected the largest hospital chains when it assembled the OMNIA tier 1 network to force "the most expensive network hospitals to moderate their prices," according to the latest version of the lawsuit, filed last week in state Superior Court in Bergen County.

New Jersey Voters Oppose Tiered Insurance Plans Such as Horizon's Controversial OMNIA

In a survey of registered New Jersey Voters, 70% of those polled stated that they opposed Horizon's controversial OMNIA plan - an insurance plan that has created a tiered web with huge hospital systems as its base, while excluding some of the state's best and highest rated hospitals. Notably, 70% of those who identified as Horizon customers also opposed the OMNIA plan, while 66% of them supported a freeze on enrollment into tiered plans until the state can set guidelines. In fact, Horizon customers supported a freeze on enrollment even more than voters overall (59%).

New poll asks whether New Jerseyans support, oppose Horizon's tiered insurance plans

A majority of New Jersey residents oppose tiered health insurance plans offered by the state's largest insurer, according to a new poll commissioned by hospitals suing the insurance giant.

Of 800 registered voters polled between April 5 and 11, 71 percent said they oppose Horizon Blue Cross Blue Shield New Jersey's OMNIA plans after being read a description of the plan, Anzalone Liszt Grove Research announced yesterday.

In September, Horizon rolled out the new plans that would create two "tiers" of providers. Hospitals classified as "Tier 1" facilities offer lower out-of-pocket expenses for patients, while some patients see higher co-pays and out-of-pocket expenses if they use hospitals in the Tier 2 network.

Poll by hospitals finds strong opposition to Horizon's tiered insurance plan

The coalition of hospitals that opposes the Omnia tiered network health plan offered by the state's largest insurer said a poll it commissioned in April found strong opposition to the new type of health coverage.

In addition, a majority of those polled held the view that Horizon Blue Cross Blue Shield of New Jersey values profits over people, according to the poll conducted by Anzalone Liszt Grove Research.

Horizon officials, however, dismissed the results, saying the questions pollsters asked misrepresented how the Omnia plan works.

Will Horizon penalize N.J. doctors for not telling patients about new health plans?

TRENTON — New Jersey's oldest physician organization has lashed out against Horizon Blue Cross Blue Shield of New Jersey, the state's largest health insurance company, for requiring doctors to explain how patients enrolled in discount plans can save more money by using a preferred network of doctors.

Doctors also must note in the patient's medical file this discussion has taken place, according to the newsletter article on the "OMNIA Tier Awareness Policy" obtained by NJ Advance Media.

Tiered network bills expose rift among Senate Democrats

TRENTON — The debate over tiered health insurance networks and how best to regulate them, ignited by the rollout of Horizon Blue Cross Blue Shield's OMNIA plans last fall, has exposed a rift among some of the state's senior Democratic senators and Senate president Stephen Sweeney.

The disagreement played out Monday at the Senate Commerce Committee hearing before a standing-room only crowd of a hundred or so executives and lobbyists representing insurers, doctors, hospitals, unions and business groups.

Sister Patricia Codey: Changing How Tiered Health Plans Are Created in NJ

Sister Patricia Codey, SC, Esq., president of the Catholic HealthCare Partnership of New Jersey, discusses legislation in New Jersey that could change the way tiered health plans are created.

A Senate committee will discuss legislation that would change the way tiered health plans are created in New Jersey. What are the key parts of this legislation? On Monday there's going to be a hearing in the senate commerce committee in regards to a package of bills dealing with OMNIA. And I really applaud the leadership of Senator (Joseph) Vitale and Senator (Nia) Gill.

Chamber Train Puts Politicians and Business Leaders Together

Demonstrators met passengers as they prepared to board the annual Chamber Train to Washington. the trip is intended to facilitate communication from all sides so nurses and NJ Transit workers were having their say.

"The Walk to Washington is the premiere networking event. What other even is there through the course of the year where politicians and business leaders, folks from nonprofits, regional chamber of commerce, everybody just networking on the train?" Michael Egenton from the NJ Chamber of Commerce said.

3 former governors to Christie: Stop Horizon's new insurance plans

Three former governors have signed an "open letter" to Gov. Chris Christie to ask he stop Horizon Blue Cross Blue Shield of New Jersey from selling a new line of health plans that threaten "to erode the bedrock of New Jersey's healthcare marketplace."

The letter, signed by former Govs. Brendan Byrne, Jon Corzine and Richard Codey, also a state senator, was written at the request of Saint Peter's University Hospital in New Brunswick, one of nearly three dozen hospitals excluded from the top tier of Horizon's discount OMNIA plans, hospital's spokesman Phil Hartman said. Saint Peter's sued Horizon in November to demand its inclusion as a "Tier 1" hospital. Saint Peter's is not mentioned in the letter.

Hospitals take next step in fight with state over OMNIA health plan

A coalition of New Jersey hospitals and health systems said it has filed its first substantive brief in a lawsuit against the state Department of Banking and Insurance over Horizon Blue Cross Blue Shield of New Jersey's controversial OMNIA Health Plans.

The hospitals were designated as "Tier 2" in the new tiered health plan from the state's largest insurer, as opposed to a "Tier 1" designation that allows for greater savings for patients.

The group is not suing Horizon, however, but challenging the state's approval of the plan in September 2015.

Opinion: Horizon's decision to cut out Catholic hospitals will cost N.J. patients dearly

By Patricia Codey

Just last week, Pope Francis visited our region and addressed Congress on how we need to do more to help our poor and under-served communities. Unfortunately, a recent decision by the state's largest insurance provider would hurt New Jersey patients and undermine the ability of Catholic health-care facilities to care for our state's most poor and vulnerable populations.

Horizon Blue Cross Blue Shield's decision to exclude more than half of New Jersey's hospitals — and nearly 90 percent of Catholic hospitals — from its new OMNIA Health Alliance is unacceptable and will have a devastating impact on our state's health-care system. One insurance company should not be able to dictate which hospitals succeed and which ones fail. However, that is exactly what Horizon is doing with its plan to designate Catholic hospitals as second-tier facilities.

CentraState, others sue Horizon over Omnia plan

Horizon Blue Cross Blue Shield of New Jersey broke its contract with hospitals when it didn't give them the chance to participate in its new health insurance plan, according to a lawsuit filed by seven hospitals on Thursday.

The hospitals, including CentraState Healthcare System based in Freehold Township, JFK Medical Center based in Edison and Trinitas Regional Medical Center based in Elizabeth also want Horizon to stop a marketing campaign that refers to them as Tier 2, according to the lawsuit.

7 N.J. hospitals sue Horizon for branding them subpar in ad campaign

Continuing the barrage of legal challenges against the state's largest insurance company, a group of hospitals sued Horizon Blue Cross Blue Shield of New Jersey Thursday for wrongly excluding them from a new line of discounted health plans and harming their reputations.

By not inviting them to join the OMNIA "Tier 1" network, seven hospitals accused the insurance giant of violating their contracts that require 60-days notice of any new product launches, according to the lawsuit.

Update: 7 health systems sue to halt OMNIA advertising

A new lawsuit has been filed against the state's largest insurer, Horizon Blue Cross Blue Shield of New Jersey, by seven hospital systems in the state.

This suit calls for a halt to the advertising of Horizon's controversial new tiered network plan and the OMNIA Health Alliance.

The seven health systems were designated Tier 2 in the OMNIA tiered network plan that Horizon announced in September and is slated to activate in January.

But the attorney representing the group, Michael Furey with Day Pitney, said the way the OMNIA alliance has been structured is unfair.

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

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, said the lawsuit, which was filed in state Superior Court in Hackensack by the two hospitals and five others. The insurer was obligated to give the hospitals an opportunity to negotiate participation in the new plans, the suit said.

Do bills targeting insurance regulations go far enough?

New bills introduced in the state Senate would address inadequacies in current insurance regulations, but many are questioning whether Band-Aid legislation will fix the overall problem: Regulations are outdated.

Holy Name Hospital CEO Michael Maron said it is obvious the state needs to update regulations.

"The current regulations could not have anticipated current market conditions," Maron said. This includes "formation of large hospital systems, the growth of Blue Cross Blue Shield as a dominant player, provider partnerships and alliances and vertical integration, and the overall insurance market."

Senators turn on tiered health plans after supporting them last year

TRENTON — State Sens. Nia Gill and Joseph Vitale introduced legislation Monday that would delay implementation of tiered health plans in New Jersey, a response to Horizon Blue Cross Blue Shield of New Jersey's OMNIA health plans, which would create a two-tiered system some hospital executives say would hurt their bottom lines.

The move comes 12 months after the same two Democrats proposed legislation (S-2603) that would have expressly protected the right of insurance carriers to offer tiered network products, by prohibiting "anti-tiering" clauses in provider contracts. Now, however, facing protests from providers who have been deemed second-tier, Vitale and Gill say they need to take a second look and want to delay Horizon's OMNIA plans until 2017.

Opinion: Banking agency review of insurance entity sought

WE HAVE ALL been hearing and reading about the new Horizon Blue Cross OMNIA Alliance Insurance product, but no one — not the consumers, not us as legislators, not the doctors or hospitals who provide our care — truly know what impact this product will have on us all. The recent joint hearing of the state Senate Health and Commerce Committees held on Oct. 5 unfortunately did not provide answers to the public at large.

Based upon my own experiences in the health care arena recently due to my personal illness, I have grave concerns regarding the lack of transparency surrounding the criteria and methods by which hospitals were chosen. I agree with comments made by senators during the hearing that characterized the creation of OMNIA as having "the earmarks of being a potential monopoly, as well as serious consumer protection issues." That the processes used by Horizon to create OMNIA, and the New Jersey Department of Banking and Insurance to approve it, need scrutiny, transparency and oversight is an understatement.

Tiered Plans Lower Costs for Some Patients, But at What Price for Others?

There's broad agreement in New Jersey that patients will benefit from the lower healthcare costs of tiered insurance coverage.

But there's little agreement on anything else about these plans.

In tiered plans, patients pay less out of pocket if they visit certain hospitals and doctors designated as Tier 1 providers.

Hospital executives and elected officials say that the introduction of the largest tiered plan yet - Horizon Blue Cross Blue Shield of New Jersey's OMNIA - could lead to the closing of a number of hospitals left out of Tier 1, if many of their patients move to providers that will cost them less.

With Horizon Absent, Trenton and Elizabeth Mayors Weigh in on Omnia

State Assembly members heard testimony Wednesday on Horizon's Omnia Alliance and its controversial tiered healthcare plans, which are facing legal challenges from an eleven-member coalition of hospitals who say they are being strong-armed into an unfavorable deal with Horizon Blue Cross. The mayors of Trenton and Elizabeth criticized the provider at the joint hearing of the Assembly Health and Services and Regulatory Oversight Committees.

Critics say hospitals that did not agree to reimbursement rates favorable to Horizon in exchange for higher patient volume have been forced to charge high rates to disadvantaged customers as second-tier institutions, setting the stage for a drop in revenue that could have its own reverberations on inner-city areas as those hospitals decline or fail. Proponents cite a need for drastic cost reductions in New Jersey, and say Horizon is merely executing a strategy that many smaller providers have already put in place. Horizon insures nearly 50% of patients across New Jersey.

Latest tiered health network hearing gets underway

"STOP OMNIA" tags were tacked onto blouses and lapels in Trenton as a hearing on tiered network insurance plans began Wednesday morning.

The joint Assembly committee hearing, with members of the Regulatory Oversight and Health committees, aimed to discuss the effects of tiered networks in the state.

Indeed, the announcement of the state's largest insurer's tiered network plan in September has triggered political controversy, and litigation in various courts around the state.

Health professionals continue to press N.J. lawmakers to stop sales of OMNIA health plans

With a month before a controversial new tiered network plan from the state's largest health insurer is scheduled to take effect, health care professionals on Wednesday pressed lawmakers to head off what they said would be disastrous effects on hospitals kept out of the network.

It isn't clear what immediate power lawmakers might have, though, since the tiered plans offered by Horizon Blue Cross Blue Shield, known as OMNIA, have already been approved by the state Department of Banking and Insurance. The department's acting director, Richard Badolato, who declined to testify before a joint legislative panel Wednesday, said earlier this week he would refuse to stop sales of the plans because doing so would "immediately trigger chaos" in the market.

Gusciora on Tiered Health Insurance Hearing: DOBI & Horizon Leave Underinsured & Urban Areas Out in the Cold

Assembly Regulatory Oversight Committee Chair Reed Gusciora held a joint hearing of his committee along with the Assembly Health and Senior Services Committee on Wednesday to examine the issue of tiered health insurance networks, which has raised concerns in recent months over certain parts of the state being shut out from access to premium health coverage.

Hospitals in Gusciora's 15th legislative district have been left out of Horizon Blue Cross Blue Shield's new Omnia Health Alliance plan, which will provide select coverage for its insured at only 22 state hospitals, leaving others with higher premiums and deductibles if they utilize hospitals not designated in either plan.

The Record: A call to dig deeper

HORIZON Blue Cross Blue Shield of New Jersey has launched a new health care insurance product, Omnia, with the stated goal of lowering health insurance premiums. While lower prices are good for consumers, there is a catch: To realize these savings, people in Bergen and Passaic counties are being steered to what Omnia designates as Tier 1 hospitals. These include Hackensack University Medical Center, Englewood Hospital and Medical Center and St. Joseph's Health Care System. Relegated by Horizon to so-called Tier 2 status are Holy Name Medical Center, The Valley Hospital, St. Mary's Hospital and New York City hospitals like New York-Presbyterian, near the George Washington Bridge. While the hospitals included in the Tier 1 plan are all fine institutions, effectively pointing patients away from other worthy hospitals may have long-term consequences.

Trenton hospitals are right to join in Horizon opposition

Plans by Horizon Blue Cross Blue Shield of New Jersey to upend the healthcare insurance world have troubling implications for Trenton and its hospitals.

So it comes as good news that Capital Health Regional Medical Center and St. Francis Medical Center are among 17 hospitals in the state challenging the behemoth insurer's misguided scheme.

Seventeen 'Tier 2' Hospitals Go to Court to Block Horizons OMNIA Plans

If Horizon Blue Cross Blue Shield of New Jersey's OMNIA health plans launch at the end of the year, they may first have to overcome both legal and legislative obstacles.

Steven M. Goldman, former commissioner of the state Department of Banking and Insurance (DOBI) under Gov. Jon Corzine, has filed an appeal on behalf of 17 hospitals that Horizon placed in its Tier 2 category of the OMNIA plan. Tier 2 hospitals will cost patients more under the Horizon plan than Tier 1 facilities and doctors.

N.J. hospitals ask state to stop approval of new OMNIA health plans

Eleven hospitals and health systems around the state — including Holy Name Medical Center in Teaneck and The Valley Health System in Ridgewood — are asking N.J. to stop its approval of the new OMNIA health plans offered by Horizon Blue Cross Blue Shield of New Jersey, the state's largest insurer.

The plans offer savings to consumers who use a preferred list of hospitals and doctors, known as Tier 1, and charge lower premiums than other Horizon plans. The hospitals challenging the state's approval were not included on the preferred list.

11 hospital systems sue state over OMNIA approval\

Eleven New Jersey hospital systems are going to court to challenge the states approval of Horizon Blue Cross Blue Shield of New Jerseys controversial new OMNIA insurance plan.

The lawsuit aims to challenge the lack of adequate coverage, as well as the danger to safety-net hospitals if the OMNIA plan succeeds in driving market share away from urban hospitals.

11 N.J. hospitals sue state for approving Horizons new health plans

Claiming the state "abdicated its responsibility" to act in the publics best interest, 11 hospitals Thursday morning will file an appeal challenging the Christie administrations approval of Horizon Blue Cross Blue Shield of New Jerseys new line of discounted health plans, New Jersey Advance Media has learned.

The hospitals want the state Department of Banking and Insurance to rescind its decision allowing the states largest insurance company to sell the OMNIA tiered network of plans before they take effect in January, or they will ask an appellate court to intervene, according to court documents that will be filed Thursday morning.

Horizons Omnia plan, a clear threat to good urban hospitals, needs an overhaul

New Jerseys dominant health insurance company, Horizon, is about to revamp the states hospital system, all on its own, following a secretive new formula it devised behind closed doors.

Not surprisingly, the plan has deep flaws and needs an overhaul. If it is put into effect as drafted, several of the states best hospitals will be crippled or forced to close. And these vulnerable hospitals tend to serve the states most vulnerable populations in New Jerseys poor cities. Catholic hospitals, in particular, would face potential ruin.

Health insurers need more oversight

CentraState Health System is on the outside looking in now, and its chief executive officer, John T. Gribbin, wants to know why. So do we.

CentraState found out it will not be included in Horizon Blue Cross Blue Shield's new health insurance network, OMNIA. The reasons why aren't clear. They should have been — before the state Department of Insurance and Banking signed off on the plan.

N.J. lawmakers ask feds to examine Horizon plan after state AG recuses himself

TRENTON — Two state senators Friday asked the U.S. Federal Trade Commission to examine the legality of a new insurance plan Horizon Blue Cross Blue Shield of New Jersey will offer next year that they fear will monopolize the market.

Acting state Attorney General John Hoffman informed state Sens. Nia Gill (D-Essex) and Joseph Vitale (D-Middlesex) that because of a conflict of interest, he would not be investigating the methods Horizon used to develop the OMNIA Alliance-Tier 1 line of insurance plans.

Lawmakers call on AG to probe OMNIA

Horizon Blue Cross Blue Shield is not off the hook after a grueling 8-hour joint Senate committee hearing resulted in a call for the Attorney General to investigate the plan for the OMNIA Health Alliance and affiliated product.

Sen. Nia Gill, chair of the Senate Commerce committee, grilled first the Horizon officials and then the Department of Banking and Insurance officials about technicalities in the alliance and product plan...

N.J. Attorney Generals Office will examine new Horizon insurance plan

A top member of the state Attorney Generals Office will review key documents pertaining to Horizon Blue Cross and Blue Shield of New Jerseys new line of insurance plans at the request of two state senators who questioned whether the company may have violated anti-trust laws.

In January, New Jerseys largest health insurance company intends to offer the OMNIA Health Alliance plans at a 15 percent discount, and with more savings available if consumers agree to use the 36 hospitals and 24,000 doctors and other...

NJ Attorney Generals Office to review Horizon two-tier hospital plans

A high-ranking official at the state Attorney General's Office will look into whether the state should intervene in the controversy surrounding the introduction of lower-cost "tiered" health plans by Horizon Blue Cross Blue Shield of New Jersey.

After acting Attorney General John J. Hoffman recused himself because of a conflict of interest, Robert Lougy, the first assistant attorney general, on Tuesday requested documents from two state Senate committees that...

N.J. lawmakers to ask AG to determine if Horizon insurance plan violates law

Two state senators said Monday night they would ask the state attorney general to investigate whether New Jerseys largest health insurer violated anti-trust and false advertising laws in developing a new plan that excludes half of the hospitals in the state.

Based on the testimony at an exhaustive and contentious hearing, state Sens. Joseph Vitale (D-Middlesex) and Nia Gill (D-Essex) said they came away concerned that Horizon Blue Cross Blue Shield of New Jersey appeared to mislead...

Gill and Vitale Call on AG to Intervene in Horizon OMNIA Case

Senate Commerce Chair Nia H. Gill and Senate Health Chair Joseph F. Vitale today called on the state's acting attorney general to investigate Horizon's new OMNIA Alliance and tiered benefits system and to establish a permanent oversight mechanism for the program.

Following an all-day hearing, the senators issued a joint statement in response to testimony delivered by Horizon, experts and various stakeholders at today's hearing of the Senate Commerce and Health...

N.J. lawmakers question Horizon on benefits plan

New Jersey's largest health insurer will move forward next year with a controversial benefits plan despite the objections of state legislators who contend it will hurt the hospitals and physicians excluded from the plan's new network.

Several times during a hearing Monday, state senators asked for more details on how Horizon Blue Cross Blue Shield decided to put which health care providers in the network...

In New Jersey, Horizons Big Reach for Value-Based Care Runs Into Political Reality

If the state's largest insurer created a plan that promised lower costs for consumers and employers, technology investments, and better healthcare quality, everyone would be happy, right?

Wrong. That's been the lesson for Horizon Blue Cross Blue Shield of New Jersey, which stunned the healthcare community last month when it unveiled its OMNIA tiered network plan...

What people are saying about the OMNIA Health Alliance

Ahead of a Senate hearing Monday, industry leaders weigh in on the controversy overshadowing the OMNIA Health Alliance product.

"There are going to be some very unhappy hospitals, systems that may find themselves on the outside looking in. That's competition. That, to me, is good. ... Unlike a publicly traded company or a for-profit...

Omnia Health Alliance Critics Seek 90-Day Delay

By all accounts Horizon is moving full steam ahead with the roll out of the new Omnia Health Alliance.

However, there's no shortage of lawmakers, health care providers and consumers who are calling on the state's largest health insurer to put on the brakes...

Bergen County lawmakers seek delay for Horizon hospital plan

The Bergen County delegation of state lawmakers as well as the county's executive and Freeholder Board have joined the effort to delay a new health plan anticipated to have a wide and possibly detrimental impact on Catholic hospitals and the uninsured.

A letter signed Tuesday by the 15 lawmakers from both parties was sent Wednesday to Robert A. Marino, chairman of Horizon Blue Cross Blue Shield, and copied to Governor Christie...

Elected Officials Move to Block OMNIA, Citing Fears About Hospital Closures

Horizon Blue Cross Blue Shield calls concerns a 'misunderstanding' of how plans will work, ask for time to roll out details.

Concerns about whether New Jersey's largest insurer's move to tiered health plans will lead to hospital closures has led legislators and local officials to call on the state to block those plans...

Horizon hospital proposal draws criticism

A backlash to a plan by the state's largest insurer to funnel patients to a select group of hospitals through financial incentives escalated Thursday, as some lawmakers asked the state insurance department to "suspend" the plan and others called for legislative hearings.

An executive of one excluded hospital said he was exploring legal, legislative and public-relations strategies to fight the move...