N.J. Attorney General's Office will examine new Horizon insurance plan

TRENTON — A top member of the state Attorney General's Office will review key documents pertaining to Horizon Blue Cross and Blue Shield of New Jersey's new line of insurance plans at the request of two state senators who questioned whether the company may have violated anti-trust laws.

In January, New Jersey's largest health insurance company intends to offer the OMNIA Health Alliance plans at a 15 percent discount, and with more savings available if consumers agree to use the 36 hospitals and 24,000 doctors and other medical providers in Horizon's new Tier 1 category.

Many of the other 36 hospitals that were not invited to participate are city and Catholic hospitals that serve a large share of Medicaid, Medicare and uninsured clients . They are crying foul because they fear they will lose many of their better paying, commercially-insured customers by being excluded from OMNIA.

State Sens. Nia Gill (D-Essex) and Joseph Vitale (D-Middlesex) requested the Attorney General "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."

First Assistant Attorney General Robert Lougy will be the handling the matter instead of acting Attorney General John Hoffman, who recused himself, according to a letter the office sent to the senators. Hoffman's father is chairman of the Robert Wood Johnson University Health system's corporate structure, and the system is a partner with Horizon in its new OMNIA Alliance plan.

Before Lougy decides "whether any action within the statutory or constitutional authority of the Attorney General may be warranted," he requested a copy of the transcript of the Oct. 5 legislative hearing on the OMNIA Alliance plan and any related documents, according to the letter from Assistant Attorney General B. Stephan Finkel.  

Trish Graber, spokeswoman for the Senate Democrats, said the documents would be delivered Wednesday and a transcript of the eight-hour hearing as soon as it is ready. The same records would be sent to the Federal Trade Commission, which Gill and Vitale also asked to intervene, Graber said.

"It is our firm belief that oversight of the OMNIA Alliance and all tiered plans will ensure fairness, transparency and consistency in the health care market and for all of New Jersey's consumers," according to Gill's and Vitale's letter last week to the FTC.

Horizon insures 3.8 million people in New Jersey. Horizon will continue offering most of its existing plans in addition to OMNIA, which executive say was designed to offer a more affordable option using doctors and physicians that are willing to take deep cuts in reimbursement.

Original article