New Jersey Superior Court Judge Frank Ciuffani Monday ordered Horizon Blue Cross Blue Shield of New Jersey provide information on why it did not include New Brunswick, N.J.-based St. Peter's University Hospital in its preferred network, according to NJ.com.
Here are five things to know about the case, as presented by NJ.com.
1. The issue surrounds the payer's new OMNIA Health Alliance health plans, which include a "Tier 1" network of hospitals that will offer beneficiaries discounted premiums.
2. St. Peter's, one of Horizon's longstanding network hospitals, said it would suffer huge losses if it could not participate in the network, from $4.3 million up to $39 million, according to the report. St. Peter's attorney told the court it was excluded without explanation, even though hospital executives met with Horizon to discuss OMNIA plans.
3. St. Peter's asked the judge to block the payer from launching the alliance and tiered networks. This request was denied in January, according to the report.
4. The hospital also argued the way the Tier 1 hospitals are marketed as the best in quality and safety is damaging its reputation, according to the report.
5. "We appreciate the court's decision to deny St. Peter's University Hospital's attempt to stop Horizon Blue Cross Blue Shield of New Jersey from offering the new lower cost OMNIA Health Plans to consumers," Horizon spokesman Thomas Rubino said, according to the report. "The court's decision ensures more affordable health insurance options will be available to New Jersey consumers, including the projected 40,000 currently uninsured who be able to afford OMNIA Health Plans in 2016."
For more background on the lawsuit, click here.
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