When some hospitals brought a lawsuit claiming Horizon's 'Tier 2' designation maligned their reputation, Horizon fired back with a lawsuit of its own.
As the fight between the state's largest health insurer and a group of hospitals heats up, Horizon Blue Cross Blue Shield of New Jersey has sued two hospitals.
The insurance giant claims public comments by Holy Name Medical Center and The Valley hospital in Ridgewood imply coverage by its new OMNIA policies is somehow deficient or dangerous.
Horizon Blue Cross Blue Shield of New Jersey is forming a network of 36 hospitals that will treat patients at a lower cost, according to company officials. (Photo courtesy of BCBSNJ) "Holy Name Medical Center and The Valley hospital have run a false and misleading ad campaign claiming, among other things, that our company 'couldn't care less' about babies," Horizon spokesman Tom Vincz said Saturday. "It's deceptive and defamatory and since Holy Name and The Valley have refused Horizon's requests to voluntarily end their attack on our company's integrity, Horizon has little choice but to bring the hospitals to court to stop their reckless statements."
The lawsuit is the latest in a tangle of litigation spawned by Horizon's September unveiling of a markedly different kind of insurance: one that offers customers much lower cost-sharing if they get treated at one of 36 'Tier 1' hospitals.
Hospitals in OMNIA's Tier 2 are still considered to be in network, but come with higher copays.
Those Tier 2 hospitals now fear the cost differential offered by the state's largest insurer will trigger a devastating loss of patients for them. Several hospitals, collectively or individually, are suing Horizon after attempts to get state regulators to block the plan failed.
In December, Holy Name and Valley sued Horizon over how the tiers were compiled, alleging breach of contract.
In addition, they and other hospitals have lobbied against the new OMNIA product through outreach to their members, the legislature, media editorial boards and the general public.
Horizon, in its lawsuit, cites a billboard sponsored by Holy Name that states, "It's your baby. You want the best. HORIZON OMNIA COULDN'T CARE LESS."
Horizon, in its lawsuit, asks the court to order the two hospitals to "immediately remove, dismantle, cease from publishing and eliminate all billboards, websites, advertisements, correspondence and writings that reference OMNIA and/or Horizon negatively."
It also seeks damages.
An attorney for the two hospitals now being sued by Horizon said they have a right to defend their reputation from the impact of being called a "Tier 2" facility.
"Through their misleading marketing and branding efforts, Horizon has led consumers to believe that Tier 1 hospitals are superior, while Tier 2 hospitals are somehow inferior," said Bruce Rosen, the attorney. "This is simply untrue."
Kathleen O'Brien may bereached at kobrien@njadvancemedia.com. Follow her on Twitter @OBrienLedger. Find NJ.com on Facebook.