Horizon's Omnia sparks debate about health plan transparency

In a hearing Monday on the topic of transparency in tiered health insurance plans--such as Horizon Blue Cross Blue Shield's Omnia--New Jersey legislators to tackled the daunting task of determining how much insurers should have to disclose when creating new products, according to the American Journal of Managed Care (AJMC).

Some legislators and hospitals want Horizon to share more than it has about the selection process it used to create Omnia, a new tiered health insurance plan that steers patients to specific providers. But New Jersey's acting attorney general said Monday that the Omnia plans don't violate any state laws.

So the debate now surrounds the need to protect consumers, according to the AJMC article, as well as what health plans' responsibility is to ensure that safety net hospitals treating high numbers of poor, non-English speaking patients aren't treated unfairly or left out.

During Monday's hearing, groups including the Medical Society of New Jersey said they plan to join lawsuits that seek to overturn Omnia's regulatory approval. Participants also discussed bills that would require more transparency in creating tiered health plans, set standards for creating tiers, give providers rights to appeal and add the Department of Health to the oversight process, AJMC said.

New Jersey Senate President Steve Sweeney-said at the hearing that he supports transparency, but also wants it to be extended to doctors and hospitals, according to the article. He testified that he wants to require insurance companies "to fully educate consumers" about their cost-sharing obligations without hurting any current products, increasing costs or threatening consumer choice.

To learn more:
- here is the AJMC article

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