Two more hospitals drop chal­lenge to Hori­zon plan

Modern Healthcare - - REGIONAL NEWS - —Erica Te­ichert

Cap­i­tal Health Sys­tem and JFK Med­i­cal Cen­ter have ex­ited a law­suit in New Jer­sey state court al­leg­ing state reg­u­la­tors shouldn’t have al­lowed Hori­zon Blue Cross and Blue Shield to place them in a lower-tier provider net­work.

JFK Med­i­cal Cen­ter, Edi­son, con­firmed last week that it had dis­missed its claims against the state’s top health in­surer with­out prej­u­dice. Tren­ton­based Cap­i­tal Health made a sim­i­lar move this month, ac­cord­ing to court fil­ings. Seven­teen hospitals ini­tially sued Hori­zon, ar­gu­ing the New Jer­sey Depart­ment of Bank­ing and In­sur­ance ig­nored its own reg­u­la­tions when it ap­proved Hori­zon and Blue Shield of New Jer­sey’s Om­nia Health Al­liance and Health Plan.

The in­surer’s plan di­vided hospitals into two tiers, and the hospitals in the suit were those in the more ex­pen­sive sec­ond tier. The hospitals claimed the tiered sys­tem could desta­bi­lize New Jer­sey’s health sys­tem by jeop­ar­diz­ing the fi­nan­cial health of hospitals in the more ex­pen­sive tier.

Last month, a New Jer­sey ap­peals court up­held the state reg­u­la­tor’s de­ci­sion to ap­prove the Om­nia plan.

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