NJ Health Insurance Company excludes Seven Catholic Hospitals from New Plan, Suit Claims

NJ Health Insurance Company excludes Seven Catholic Hospitals from New Plan, Suit Claims

By Heather Krause

Catholic hospitals in New Jersey are being discriminated against, according to a lawsuit filed by St. Peter’s Hospital.

Horizon Blue Cross Blue Shield is a well-known New Jersey health insurance company that has been around since 1932.

This company goes by the saying, “We don’t just work in New Jersey, we live here, and we work hard to make sure our families, friends and neighbors have access to quality, affordable care.”

Horizon Blue Cross Blue Shield has a mission, but St Peter’s has alleged the insurance company is secretly excluding seven different Catholic Hospitals in the state from its new “OMNIA Tier One Plan.”

Within the next year, many other New Jersey hospitals will be receiving better insurance rates from Horizon, under the “tier 1 plan”.

The seven hospitals that Horizon has chosen to exclude are the most expensive hospitals in New Jersey. This will make the patients have to pay more than they already do for a hospital visit.

The controversial plan has been the subject of hearings in the state legislature, and some legislators have asked the Attorney General to investigate.

Assemblywoman Valerie Vainieri Huttle, a state lawmaker, defended Catholic hospitals. She was quoted by NJSpotlight as saying, “I sincerely hope that Horizon did not intentionally keep Catholic hospitals out of its tier 1 plan.”

Many people are wondering why Horizon would discriminate against certain religious hospitals. These so-called tier one providers were handpicked by Horizon in a process, but there are many concerns among the excluded hospitals.

“Often, Catholic hospitals serve poorer communities,” said Huttle. “These are the residents who are most in need of less costly but still high quality healthcare. If these claims are true, they are unacceptable.”

On October 9, two other New Jersey lawmakers asked that Horizon delays the new tier one plan because they believe that what Horizon is doing is unfair to the Catholic Hospitals.

The state’s acting attorney general John J. Hoffman declined to get involved due to his father being a part of the Robert Wood Johnson Health Care Corp. John J. Hoffman later resigned as Attorney General to take a job at Rutgers University.

Robert Wood Johnson’s multiple hospitals are included in the tier one plan which is a given opportunity for them to act upon this new plan.

Lawmakers Nia Gill and Joseph Vitale have asked Hoffman to get involved after a hearing on October 11 when they learned that the OMNIA plan was approved despite concerns that it did not offer enough access to obstetrics care in Trenton and Burlington County.

State officials said Horizon committed to filling the gap but those plans are not yet settled.

On Friday, November 6, St. Peter’s University Hospital sued Horizon because they were not invited to participate in the Tier One plan.

St. Peter’s was among the 36 hospitals that are part of the “Tier Two” plan whose patients will be able to use Horizon, but have to pay more money out of their pockets that the insurance will not cover.

Jeffrey Greenbaum, the hospital’s attorney stated, “We are going to request the OMNIA program be enjoined until Saint Peter’s is given a fair opportunity.”

St Peter’s argued that because faith-based care systems, specifically the seven Catholic Hospitals, were excluded from the Tier One Plan, many Catholic patients will not be able to receive the care that they need.

A letter was sent to Horizon from the New Jersey Catholic Conference, an organization that represents the bishops, asking that Horizon CEO Robert Marino to let the hospitals apply for Tier One status.

Horizon is expected to continue on with the new Tier One plan within the next month, but there are still many questions as to why certain hospitals were picked and others were not.