Is Horizon Omnia acting badly by requiring your primary physician to explain their controversial tiered plans? The NJ Medical Society is annoyed that Horizon is forcing primary doctors to explain or defend their tiering system of doctors in NJ. For those who have Horizon Blue Cross Blue Shield, chances are they switched you at your renewal date to one of their tiered plans, which eliminated 40 hospitals and indemnified large hospital monopolies under their tier 1. There is a good chance you were likely priced out of your older plan and chose a more affordable plan, only to find out the doctors you really want and trust are in the more expensive tier 2. Horizon is saying the large hospitals negotiated lower fees in return for tier 1, except the hospitals that are in tier 2 were never given a chance to negotiate. We also know now that the rates paid to the larger systems are no different than before. They just picked winners and losers based on size and market clout. Something smells bad here. Horizon has chosen to shrink the NJ hospital market with an economic tourniquet. Their efforts worked as smaller hospitals aborted their lawsuits and found that it was easier to pay a larger hospital systems membership fees and then the doctors and the hospital become tier 1. Horizon is also forcing doctors to explain this to patients and place it in their notes, something that is not their job or be removed from the plan. In other words, comply or you are toast. You can read more about this as it was featured in NJ.com here Will Horizon penalize N.J. doctors for not telling patients about new health plans? TRENTON “” New Jersey’s oldest physician organization has lashed out against Horizon Blue Cross Blue Shield of New Jersey, the state’s largest health insurance company, for requiring doctors to explain how patients enrolled in discount plans can save more money by using a preferred network of doctors. If doctors don’t discuss “the cost-sharing implications” of using “Tier 1 or 2” doctors and hospitals with their patients who are enrolled in Horizon’s OMNIA plans, they “may be subject to consequences, up to and including termination from Horizon BCBSNJ’s networks,” according to a newsletter Horizon sent doctors last month. Doctors also must note in the patient’s medical file this discussion has taken place, according to the newsletter article on the “OMNIA Tier Awareness Policy” obtained by NJ Advance Media. Read more The Medical Society of NJ is appalled and so are we. Horizon Omnia also has 86% participation of all physical therapists in tier 1 vs 5 % of chiropractors which have much higher levels of satisfaction as per Consumer Reports and other trusted sources. In the eyes of the public, chiropractors get the job done for less but Horizon made chiropractors tier 2, making you pay more to see these more effective providers of care for pain. That is crony capitalism at its best, and will certainly cost you more to benefit who? Insurance companies ideas are partly what has raised the cost of care to where we are now, outrageous. Most people when they buy these plans do not know the difference until they find out their more effective doctor is in tier 2 and what used to be a $40 copay is now a $3000 deductible and then they will pay a percentage, for a savings of maybe 15% on their monthly premium. Is your doctor supposed to explain these strange economics or get booted out of the plan? Just in case you are wondering, chiropractors in tier 1 and tier 2 all have the same fee schedule as well; so much for their narrative. We as consumers should be upset since we are being forced to buy a product even our insurance agent has a hard time understanding. We expect the insurance company to be honest in their intentions of saving us money, so if they do, why does an in-network MRI cost more than if I wanted to pay the radiology center cash.. In reality, insurance companies change their products to suit their bottom lines and underhanded deals, and in the case of Horizon, want to legitimize it by forcing your doctor to explain why your favorite and most effective doctor is in tier 2, but he is forced to recommend tier 1, forcing you to pay more. Confused; you should be. A 15% savings sounds good until you use your plan and find out that you are now spending more than you saved in premiums, to see the providers you trust, and now they are having your doctor treat your insurance, instead of spending time with you. Is it any wonder the NJ Medical Society is upset. Where is the Dept. of Banking and Insurance in all this and how is this ok? Who paid them to look the other way and allow this to happen? You should voice your complaints to the Department of Banking and insurance. It takes a few minutes to file a complaint on line at http://www.state.nj.us/dobi/index.html.