Physicians want more answers about N.J. insurer's proposed status change

Opponents say Horizon's plan to convert to for-profit is lacking transparency. The insurer argues that too much information could hurt its ability to compete.

By Emily Berry — Posted April 15, 2009

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Horizon Blue Cross Blue Shield of New Jersey in March filed more than 350 pages of responses to state regulators' questions over its proposal to convert to a for-profit insurer. But the Medical Society of New Jersey, the state's hospital association and other opponents to the conversion say that volume of words didn't provide sufficient answers.

In a letter sent to the state's attorney general and insurance commissioner March 26, the groups argued that Horizon's application is incomplete and has a "lack of transparency."

"The Horizon responses do not make the conversion process more transparent, but rather less so, and do so in ways that we believe transgress the conversion statute's careful balancing of the public's right to know against the applicant's need to preserve information that is proprietary or privileged," the letter said.

Along with the medical society and hospital association, the letter was also signed by the president of the Catholic HealthCare Partnership of New Jersey, the president and chief executive officer of the Alliance for Advancing Nonprofit Health Care and the president and CEO of QualCare, a physician- and hospital-owned health plan based in Piscataway, N.J.

Horizon spokesman Tom Rubino said the company can't answer some questions publicly because it would mean disclosing business plans. "We believe we're trying to work in the framework of the statute, be as transparent as possible but also run our business in a competitive environment."

As of early April, the commissioner and attorney general had not ruled the Horizon application complete. That step would set the ball rolling for public hearings and the official evaluation of the application by state regulators. Once the application is deemed complete, the state has 90 days to schedule public hearings.

Horizon filed its application Aug. 15, 2008, and in October the state's insurance commissioner and attorney general ruled the initial filing incomplete. The state asked for more information about the company's financial justification for converting, its need for its multimillion-dollar surplus, and its rate-setting practices.

Opponents of the conversion worry the company would be acquired by for-profit WellPoint, the nation's largest private-pay insurer, which has grown with a strategy of acquiring Blues-licensed plans.

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