Lawmakers Worry Horizon Plan Could Hurt NJ Hospitals

September 28, 2015 – In The News

Elizabeth G. Litten was featured in the Law360 article “Lawmakers Worry Horizon Plan Could Hurt NJ Hospitals.” Full text can be found in the September 28, 2015, issue, but a synopsis is below.

Horizon Blue Cross Blue Shield of New Jersey has recently unveiled plans to cut cost while maintaining quality care with a new tier system. The health insurer also has plans of defending Omnia Health Alliance, who has a legislative hearing regarding the new program in the upcoming weeks. The introduction of the new coverage program has some questioning the ability for patients to access medical treatment and the financial effects of the providers associated with lower tiers.

Elizabeth G. Litten believes that Horizon may not be expecting as many Omnia participants in Tier 2 hospitals, which may cause access issues if these types of situations are not addressed. If insurers do not take this into consideration, the cost differential between tiers may have consequences when considering emergency care.

“I would imagine there's going to be a demand for the Department of Banking and Insurance to really keep an eye on whether the projections offered by Horizon to get this product approved actually bear out in terms of where their buyers live,” Litten said.

She continues by addressing the possible negative effects of labeling hospitals in a tier system. According to Litten, hospitals may suffer from the perception of individuals believing that Tier 1 hospital care is better than Tier 2 strictly based off of the number. She also goes on to mention that Tier 2 may lose referrals due to doctors having ties with Tier 1 hospitals and will send individuals there to keep cost down.