Horizon’s Blue Cross Blue Shield’s newest idea; Omnia, should the buyer beware?
Omnia, Horizon’s controversial new product has been making news for months, as it is a tiered product, with 40 or so hospitals being listed a tier 2, while the larger hospital systems were invited in as tier 1. For those who use chiropractors, two per county are tier 1 and the rest of the 1700 chiropractors are tier 2. In physical therapy, 86 percent are tier 1 and 14 percent are tier 2.
What is the difference in the tier’s and how did they come up with this product. Are consumers getting value, or a great sales job, as the big healthcare behemoths are tier 1 and those with little clout with the insurer are tier 2 and is this really about quality and cost, or making healthcare even more about big business and less about the patients and the doctors they trust?
Historically, Horizon began its Obamacare healthcare journey with two plans; Advance and Advantage. On the exchanges, these looked similar but the Advance had a lower premium, less coverage and a more restrictive network of doctors, something they had problems understanding using the National healthcare exchange for NJ. To make matters more confusing, they two plans had similar names.
Last year, Horizon announced they were folding their Advanced plan and introducing Omnia, which had two tiers. Suspiciously, Tier 1 had the two chiropractors per county as Advanced did, and the same proportion of physical therapists. It looks like they took their Advanced plan, rolled it into Omnia and called it Tier 1, while the rest of the healthcare professionals were listed as Tier 2, who now have higher co payments or deductibles.
As before, Advanced cost a little less, and their Bronze plans were a lot less, but had high deductibles. With the new Omnia plans, patients are buying one product, not two, so if they can no longer purchase the wrong plan, since there is only one plan on the exchange, a good reason to buy coverage through an agent who will explain the plan to you better than the exchange will. Also, they can no offer many more plans within the same plan at lower rates, although to be fair, the plans are not the same, if you save a couple of dollars monthly, and your doctors are now all tier 2, and have a $2500 yearly deductible, with a high cost share, while their more limited tier 1 (this is not about quality, but market clout), gives you more access.
If you want to see your tier 2 doctor for less, you buy a plan that has a higher premium and the copay and deductible comes down to reasonable levels. Knowing how most insurers work, they are likely to jack up the premiums to make Tier 2 less affordable, trying to manipulate the marketplace. Is that fair, and is it legal for a monopoly in healthcare in NJ to coddle monopolistic hospitals, and harming the public, great doctors and healthcare providers and the patients who buy the plans? Can Horizon show us that they did actually get more favorable terms from those Tier 1 providers (Chiropractors have the same fee schedule regardless of the tier).
They are advertising this idea as a money saving idea that is consumer friendly, with bigger premium discounts, but is it really that, or an attempt to cause the public who is already confused and frustrated by high out of pocket costs and copayments to choose the cheaper plans, and find out their doctors now cost them even more. Furthermore, the consumer is now likely to find that the affordable plan is actually costing them more, when you combine out of pocket costs to access the larger network.
Is the Department of Banking and Insurance closely watching this; I hope so. Healthcare insurance from Horizon is not for the uneducated and uninformed, who are likely to choose the less expensive plan, and then wait until their high deductible is met to see those they need to see. Chronic healthcare problems cost more to treat, and with high deductibles and copay’s you pay more, they pay less, and for a small discount. This is not any different from researching a flat screen television, finding one is$699, the other $499 but neither of them has the description written in English and they come from the same manufacturer. Naturally, they look the same and feel the same, but you never saw it out of the box, until you take it home and find out the $499 tv will have only one input, not interface with half of your gear and nobody will take it back; Caveat Emptor.
If you are buying health insurance, or thinking of an Omnia plan, please do your due diligence, and make sure the people you use and rely on are adequately covered in the plan. The only one watching out for you is you. You are likely to do best using an agent who can explain things to you and ask about copays and tiers when you decide to buy. We can recommend one if you need one.