Images of the Horizon Blue Cross Blue Shield
headquarters in Newark. The state Attorney General's Office issued a
letter saying the insurance company broke no laws in creating its new
discount products known as OMNIA. (Matt Smith | For NJ Advance Media)
TRENTON — Horizon Blue Cross Blue Shield of New Jersey broke
no state laws in creating its controversial new discount OMNIA health
plans last year, according to a letter from the acting Attorney General
released Friday.
The letter comes five months after Sens. Nia Gill (D-Essex) and Joseph Vitale (D-Middlesex) asked the Attorney General to "delay Horizon from
offering the OMNIA tiered plans" until his office established "a
permanent oversight mechanism for the process for tiering and rating
health care providers in New Jersey."
The lawmakers have championed the cause of hospitals Horizon excluded
without explanation from OMNIA's "tier 1" category that offer policy
holders a deal on premiums and copays.
Some of the "tier 2" hospitals — many of which are Catholic-owned and
serve low-income and uninsured patients — are suing to fight their way
into the highest tier, out of fear they will lose too many of their
privately insured patients and have to close.
Horizon plan worries excluded hospitals
In the fall, First Assistant Attorney General Robert Lougy, who on
Monday was named acting Attorney General by Gov. Chris Christie, said he
would review the transcript and any related documents from an Oct. 5
legislative hearing. At that hearing, Horizon and state insurance
regulators who approved the plans were grilled about how OMNIA was
created.
The records would help his team decide "whether any action within the
statutory or constitutional authority of the Attorney General may be
warranted," according to a letter from Lougy's office.
Loughy replied in a brief letter to Gill, Vitale and Horizon, saying the inquiry was over.
"At the request of members of the Legislature, the Attorney General
has undertaken a careful review into the OMNIA Health Alliance
established by Horizon Blue Cross Blue Shield of New Jersey to determine
if the implementation or operation of the Alliance violates New Jersey
law. The Attorney General has determined that no further action is
warranted as a result of that review," according to the letter.
Vitale said he was disappointed.
"i appreciate the letter but it was not what we asked the Attorney
General to do," Vitale said. "We wanted an ongoing role — a level of
oversight by those independent eyes and ears for health care consumers
because I did not believe the Department of Banking and Insurance did
its job. We could not allow Horizon to decide state health policy and
which hospital succeeds and which suffer."
Gill said "The Attorney General's lack of response makes it even more
important that we work on legislation to establish parameters for
tiered networks and transparency in the process."
Those bills are up for hearing and vote in the Senate Commerce Committee, which Gill chairs.
A Horizon spokesman declined to comment.
Steven Goldman, attorney for 17 "Tier 2" hospitals challenging the state's decision to approve Horizon's OMNIA network, said he was not surprised by the acting Attorney General's letter.
"We continue to believe that (the
Department of Banking and Insurance) has not fulfilled its
responsibility to take into account the public interest in its review of
the OMNIA plan, nor do we believe that the plan has met DOBI's network
adequacy requirements," Goldman said.
"If OMNIA is allowed to continue,
New Jersey's healthcare system — including patients, doctors, and
hospitals — will be adversely affected."
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