St. Peter’s University Hospital, in New Brunswick, N.J., is suing the state’s largest insurer, Horizon Blue Cross and Blue Shield of New Jersey, asserting that the hospital was wrongfully excluded from a discount insurance plan called Omnia Health Alliance.
In response, Horizon Public Affairs Director Thomas Rubino said, “It is unfortunate St. Peter’s, one of our long-standing network hospitals, would choose litigation instead of conversation on how we can work together to provide those we both serve with access to lower-cost healthcare.”
Omnia, a two-tier health plan, will provide 15 percent premium discounts to patients who use a Tier 1 facility or physician. Tier 2 hospitals, including St, Peter’s, do not receive similar discounts.
St. Peter’s asserts that Omnia classified the hospital as Tier 2 without notice and without giving the hospital an opportunity to apply for Tier 1 status. The hospital is arguing that its contract with Horizon mandated that St. Peter’s be advance notice of the new network and its criteria.
A hospital spokesman says it spends nearly $39 million annually on care for the uninsured, community outreach and its clinic.