Saint Peter's sued Horizon over what it said was its wrongful exclusion.
A New Jersey Superior Court has ruled that Horizon Blue Cross Blue Shield of New Jersey cannot be forced to include Saint Peter's University Hospital in its new discounted health plan until a lawsuit between the two is resolved.
Judge Frank Ciuffani made the decision on December 24, telling both sides to return on Monday Jan. 4, 2016, to schedule depositions and a full hearing, according to ajmc.com. Ciuffani told the parties he wants the matter resolved quickly.
Saint Peter's Healthcare System filed suit against Horizon Health Services, Inc. over what it said was its wrongful exclusion from the preferred Tier 1 network of the health insurer's newly launched OMNIA Health Alliance, which was publicly announced in early September.
St. Peter's said it was excluded in the plan offered by the state's largest health insurer because it and other independent, Catholic hospitals serve low income residents, according to the health system. It argued it would suffer irreparable harm, including lost revenue and damaged relationships with patients, once the OMNIA plan takes effect.
Horizon called the ruling favorable as it means the new, lower cost health plan coverage will take effect on January 1.
"Horizon is pleased that the Court has refused this effort by St. Peter's to change the implementation of Horizon's OMNIA Health Plans," Horizon said in a statement. "This is good news for the thousands of individuals who have purchased OMNIA Health Plans to date. They can rest easy over the holidays knowing their new, lower-cost OMNIA Health Plan coverage will be effective come January 1, 2016."
Saint Peter's in a statement praised the court's decision to hold an expedited trial in the case.
"While we are disappointed that the court did not require Horizon to designate Saint Peter's an OMNIA Tier 1 hospital while our lawsuit continues, we take note that the court is asking for an expedited trial date to resolve all our claims against Horizon, after which it will consider whether to order Horizon to name Saint Peter's a Tier 1 OMNIA partner," St Peter's CEO Ronald C. Rak said.
OMNIA Health Alliance is a collaboration of Horizon Blue Cross Blue Shield of New Jersey, six New Jersey hospital systems and a major physician group.
In an earlier decision, Judge Ciuffani refused Saint Peter's request to halt OMNIA from moving forward with the new network in January 2016.
The OMNIA Health plans divide New Jersey's hospitals into Tier 1 and Tier 2 groups. Under the plan, consumers have access to all of Horizon Blue Cross Blue Shield of New Jersey's current hospitals and physicians, but those who choose Tier 1 hospitals and doctors pay lower out-of-pocket costs.
St. Peter's was in Tier 2, though it said it met quality ranking standards to be in Tier 1. All Catholic hospitals except Saint Joseph's in Paterson, New Jersey were excluded from Tier 1 status, according to Saint Peter's.
Horizon officials said this fall that hospitals and doctors were selected based on their commitment to value-based care, strong clinical quality, consumer preference and multiple service offerings.
Horizon Chairman and CEO Robert Marino said this fall that OMNIA Health Alliance was formed as a response to the high cost of healthcare in New Jersey. Residents pay the second highest healthcare costs in the country and costs are rising 25 percent faster in New Jersey than the national average, he said. The new OMNIA plans will offer monthly premiums that are 15 percent lower than Horizon's standard plans, he said.
Healthcare providers will take discounts in their reimbursements, according to Horizon, but are expected to make that up with added volume.