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Sunday, June 26, 2016

CAPITAL HEALTH SYSTEM, INC., ET AL. VS. HORIZON HEALTHCARE SERVICES, INC./ SAINT PETER'S UNIVERSITY HOSPITAL VS. HORIZON HEALTHCARE SERVICES, INC. A-2913-15T2/A-2929-15T2

 CAPITAL HEALTH SYSTEM, INC., ET AL. VS. HORIZON HEALTHCARE SERVICES, INC./ SAINT PETER'S UNIVERSITY HOSPITAL VS. HORIZON HEALTHCARE 
SERVICES, INC. 
A-2913-15T2/A-2929-15T2(CONSOLIDATED) 
These two back-to-back appeals are related to our June 7 opinion in Capital Health Sys., Inc. v. N.J. Dep't of Banking & Ins., ___ N.J. Super. ___ (App. Div. 2016), where we affirmed the Department of Banking and Insurance's decision approving Horizon Blue Cross Blue Shield of New Jersey's (Horizon's) application to establish the OMNIA Health Alliance (OMNIA) network. Several of the hospitals in that case brought actions in the Chancery Division against Horizon alleging that the insurer breached its contracts with them by, among other things, not including them as Tier 1 hospitals in the new OMNIA network. The trial courts granted the hospitals' requests for discovery of a consultant's report Horizon used to select and tier the hospitals for the network, contracts between Horizon and the OMNIA hospitals, and other proprietary business information concerning the formation of the network. 

In our decision, we considered the relevancy of this material to the hospitals' claims, and then balanced it against Horizon's need to maintain the confidentiality of material which, if disclosed, could give plaintiffs a competitive advantage over other hospitals in each of their service areas and over the insurer in future negotiations concerning rates. As a result of this balancing, we ordered specific redactions to be made in the materials sought by the hospitals.