Striving for transparency in tiered health plans, N.J. lawmaker considers legislation

New Jersey lawmakers say legislation may be needed to ensure the process of creating tiered health plans is open and transparent.

Horizon’s OMNIA tiered network was developed without clearly explaining why certain hospitals were designated as tier 1 and others as tier 2 — with higher out-of-pocket patient costs, said Assembly Minority Leader Jon Bramnick, R-Union.

“Horizon Blue Cross Blue Shield is by far the biggest provider of health care. If Aetna or the other carriers did it and did it wrong, we’ll get to that at some point,” he said Thursday at a Statehouse news conference. “But they are so big, so powerful, and touch so many hospitals, we need to start there.”

Dr. Robert Pedowitz, a primary care physician at CentraState Medical Center in Freehold, said his patients have to choose whether to pay more for hospital care there or travel to a tier 1 hospital to save money.

“So if our patient drives over an hour to get the care that they can get by walking or being wheeled in a wheel chair just right down the hall from our office, I mean it’s really a shame that this is what is happening to health care,” he said.

Assembly Health Committee Chairman Herb Conaway, D-Camden, said the development of tiered networks should be open and transparent and not negatively impact the doctor-patient relationship.