NJ court backs regulators' decision on Omnia health plan
A New Jersey appeals court backed the decision last year by New Jersey Department of Banking and Insurance to approve Horizon's two-tiered Omnia health plan, which has lower out-of-pocket costs at Tier One hospitals.
A New Jersey appeals court backed the decision last year by New Jersey Department of Banking and Insurance to approve Horizon's two-tiered Omnia health plan, which has lower out-of-pocket costs at Tier One hospitals.
Ten health systems not included in the lower-cost tier, including Kennedy Health, Our Lady of Lourdes Health Care Services, and Virtua, appealed the insurance department's approval of Ominia.
They argued to the Superior Court of New Jersey's appellate division that Omnia did not meet various standards for network adequacy, was not in the public interest, and was approved in a rushed review.
The court disagreed on all points, concluding that the insurance department's decision "was neither arbitrary, capricious, nor unreasonable."
Kevin McArdle, a spokesman for Horizon, called the decision a "win for consumers seeking relief from skyrocketing medical bills."
The hospital coalition's attorney, Steven M. Goldman, said the group was disappointed and will weigh its legal options.
"Horizon's lack of transparency in the selection process deprives healthcare consumers of the ability to make intelligent healthcare choices and destroys any legitimacy for its Omnia plan, he said.
Horizon Blue Cross Blue Shield of New Jersey has reported that 235,000 people signed up for Omnia. The company administers health benefits for 3.8 million consumers.
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