Saint Peter’s and Horizon end litigation involving health insurance plan coverage
April 14, 2021
Saint Peter’s Healthcare System and Horizon Blue Cross Blue Shield of New Jersey announced on April 7 that they have ended their five-year dispute. Saint Peter's New Brunswick hospital will become a Tier I facility effective May 1, according to the agreement.
Horizon introduced its OMNIA health plan in 2015, sparking multiple lawsuits. Hospitals claimed the health insurance company's Tier I and Tier II designations were unjust. All of the suits have been settled.
The OMNIA plan gives enrolled members the flexibility to use any hospital participating in its network and any participating physician in the BCBSNJ managed care network. However, individuals insured by BCBSNJ maximize their benefits and incur lower costs when they use OMNIA Tier 1-designated physicians and hospitals, according to horizonblue.com.
“We are pleased to have reached an agreement settling our legal dispute. Instead of continuing to focus on our differences, we look forward to working together to advance health care quality, affordability and the customer experience," according to a joint statement issued by Saint Peter’s and Horizon. "(We) will continue our long history of collaboration to further enhance this partnership to improve the health and well-being of those we serve.”
Leslie D. Hirsch, CEO of Saint Peter’s Healthcare System, says: “We are indeed pleased that Saint Peter’s has reached a settlement with Horizon BCBSNJ to end the litigation and to put this issue behind us. We have always valued our long-standing relationship and look forward to working together to advance our collective missions to serve the health care needs of our patients and communities,” said.
Allen Karp, Horizon BCBSNJ’s executive vice president for health care management and transformation, agreed. “We’re excited to work with Saint Peter’s to expand models of care and reimbursement that have proven effective at improving health care quality, affordability, and convenience for our members. OMNIA Health Plans empower our members to achieve their best health, give them more control of their out-of-pocket expenses, and include every doctor and hospital in Horizon’s managed care network,” he said.
Consistent with other aspects of the relationship between the two parties, the terms of the agreement will remain confidential.
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ABOUT SAINT PETER’S HEALTHCARE SYSTEM
Saint Peter’s Healthcare System Inc., parent company of the Saint Peter’s healthcare delivery system, is comprised of Saint Peter’s University Hospital, a 478-bed acute-care teaching hospital and state-designated children’s hospital and regional perinatal center; Saint Peter’s Foundation, the fundraising arm of the hospital; Saint Peter’s Health and Management Services Corp., which oversees outpatient facilities, including the CARES Surgicenter; and Saint Peter’s
Physician Associates, a network of primary and specialty care physician practices. Saint Peter’s is a regional specialist in cancer care, diabetes, geriatrics, orthopedics, bariatric surgery and head and neck surgery and is a sponsor of residency programs in obstetrics and gynecology, pediatrics, and internal medicine. Saint Peter’s is sponsored by the Roman Catholic Diocese of Metuchen and is a major clinical affiliate of Rutgers Biomedical Health and Sciences.
ABOUT HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY
Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer is a tax-paying, not-for-profit health service corporation, providing a wide array of medical, dental, vision and prescription insurance products and services. Horizon BCBSNJ is leading the transformation of health care in New Jersey by working with doctors and hospitals to deliver innovative, patient-centered programs that reward the quality, not quantity, of care patients receive. Learn more at www.HorizonBlue.com. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association serving more than 3.6 million members.