Menu Close

Two Hospitals Say They Are Being Downgraded to Tier 2 of Horizon’s OMNIA Plans

Posted in Hospitals and Institutions, Litigation, Private Insurers, State Matters

Day Pitney’s Michael Furey was quoted in a Politico article about two hospitals that will be downgraded to second-tier status by New Jersey’s largest insurer, Horizon Blue Cross Blue Shield of New Jersey, in its value-based health plan called OMNIA. The status level of a hospital in the two-tiered ranking system is of “particular importance,” according to the article, because the plan encourages customers to choose Tier 1 hospitals and doctors.

Day Pitney is representing three other New Jersey hospitals in a lawsuit against Horizon Healthcare relating to its OMNIA health plan. While neither of the hospitals whose status is being changed is involved in the lawsuit, according to the article, the plan to downgrade them “is sure to raise new questions about the validity of Horizon’s selection criteria.” In the article, Mike said, “This tier reshuffling suggests the selection process was not as thoughtful as Horizon has claimed.” He continued, “It is also at odds with Horizon’s contention in the litigation where my clients seek Tier 1 designation that it cannot add new Tier 1 hospitals.”

Mike and Dennis LaFiura are representing three of the plaintiff hospitals – CentraState Medical Center in Freehold, Holy Name Medical Center in Teaneck, and Valley Hospital in Ridgewood. The case, Centrastate Medical Center Inc. et al v. Horizon Healthcare Services Inc., is pending in the Superior Court of New Jersey, Chancery Division.

Leave a Reply

Your email address will not be published. Required fields are marked *