In the middle of the ongoing controversy surrounding Horizon Blue Cross Blue Shield's OMNIA plans and alliance, one man is taking action.
Michael Maron, president and CEO of Teaneck, N.J.-based Holy Name Medical Center, is leading a fight against the insurer and its plans, according to NJ.com.
Mr. Maron is leading a coalition of hospitals — including Holy Name Medical Center — that have been classified as Tier 2 facilities under Horizon's OMNIA plans. He's taking the case before the residents of HudsonCounty, who make up the largest constituent of Holy Name's patients.
"The general public perceives Tier 2 as being lesser quality," Mr. Maron said, according to the report. "They're perpetuating this myth that there is this valid criteria that we failed to meet, and so people believe that because of their size."
Mr. Maron believes Horizon's selection process for its OMNIA Alliance and Tier 1 facilities was not transparent, and that the OMNIA plans were intended to "shift business" to Tier 1 hospitals, according to the report.
"What we've objected to all along on this, and continue to object to, is the manner in which this was rolled out and done," Mr. Maron said. "There was no transparency, no communication as to the formation of this network and alliance. It was all done under a veil of secrecy."
Horizon has defended the tiers in its new plans. "Tiers are common among insurance carriers in New Jersey and across the country, and Horizon has been more transparent about the criteria that made up our OMNIA Health Alliance than any other health insurance company," said Thomas Vincz, a Horizon spokesman, according to the report. "The OMNIA Alliance and the tiered network of OMNIA products were carefully crafted in compliance with all regulations and laws applying to our business."
In an attempt to block the advertising of OMNIA plans, a number of Tier 2 facilities filed a lawsuit against Horizon in December, according to NJ.com. In late January, Horizon filed a lawsuit against Holy Name Medical Center and Ridgewood, N.J.-based The Valley Hospital, according to NJ.com. Horizon claims the hospitals have led a "false and misleading campaign" against OMNIA, according to the report.