| Horizon Direct Access FAQs |
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Questions and answers about Horizon Direct Access
Q. What is Horizon Direct Access?
A. Horizon Direct Access is a health plan that gives you flexibility in choosing your medical care. You can coordinate your care through your Primary Care Physician (PCP) to obtain the highest level of benefits (the selection of a PCP is optional), visit a physician in the Horizon BCBSNJ Managed Care Network, or go directly to any licensed doctor. The plan also covers you throughout the United States and around the world through the BlueCard® PPO program.
Horizon Direct Access is a managed care plan that gives you access to many health care services and programs and our large participating physician network. We've made your health care plan easy for you to understand and use. We offer preventive care benefits, emergency medical care, away-from-home care, and value-added programs.
Q. How do I find a participating Horizon Direct Access provider?
A. Call 1-800-355-BLUE (2583) toll free from any location. (This phone number is printed on your ID card.) You may also call the provider's office directly to verify that he/she is a participating Horizon Direct Access physician or health care practitioner. You can also find information online via this Web site by selecting the Physician Directory feature.
Q. Whom do I call for customer service?
A. Call Horizon BCBSNJ's dedicated Member Services Department at 1-800-355-BLUE (2583) for any service or claim issue. You can also call this number to obtain claim forms or claim submission information. Our Member Services Department is open Monday through Friday, 8 a.m. to 8 p.m., Eastern Standard Time.
Q. What happens if I use a nonparticipating provider?
A. Out-of-network care is any medical care or service you receive from any physician or health care professional in any health care facility that does not participate in the Horizon Managed Care Network. Eligible out-of-network care received in a doctor's office, hospital, or other health care facility is paid at a lower level of benefits. This means you share in more of the costs when you do not use a participating physician, health care professional, hospital, or other health care facility.
Q. Will the physician or health care practitioner file my claim?
A. When you visit your Primary Care Physician (PCP), he/she files claims for you. Horizon BCBSNJ's Member Services representatives can answer any questions about the status or payment of a claim. The toll-free Member Services number is on your ID card.
Q. Whom do I speak to if I have questions about a bill that I receive?
A. You should contact the Customer Service department at (800) 355-2583. If you are not satisfied with the results, you should contact the Benefits Office.
Q. What happens if I lose my medical card?
A. You should notify Horizon's Customer Service department at (800) 355-2583.
Q. My children are attending college in another state. Are they still covered under my health plan?
A. When your children go off to college, their health care benefits travel with them. With BlueCard PPO, students don't have to worry about filing complicated claim forms or dealing with billing hassles. They simply need to present their ID card before receiving care from a participating provider and pay any applicable copayments. BlueCard PPO takes care of the rest. They can use any BlueCard PPO provider in the state where they are residing just as they would if they were home with you.
Q. Is it easy for my children attending college in another state to find a participating provider?
A. The BlueCard PPO program provides established health care networks to more than 85 percent of the United States population. Members enjoy access to the largest health care network in the nation, featuring over 6,000 participating hospitals and more than 600,000 participating physicians, specialists, and subspecialists. To locate the names and addresses of participating practitioners in their area, students can call 1-800-810-BLUE (2583). Students can also use this Web site to locate providers online.
Q. Are there services that require pre-authorization?
A. Yes, certain services may require pre-authorization. Check with your employer or Horizon BCBSNJ's Member Services Department for specifics about which services under your program may require such approval. You or your physician are required to contact Horizon BCBSNJ's Care Management Department at the number on your ID card to obtain pre-authorization.
Q. How do I obtain pre-authorization for other services from Horizon BCBSNJ?
A. Your ID card lists a toll-free number for pre-authorization. It is your responsibility to obtain pre-authorization when it is required. Without pre-authorization, there may be a reduction in benefits or no benefits may be paid, depending on the terms of coverage.
Q. If I am traveling away from home and require medical care, how does Horizon Direct Access help me?
A. You have peace of mind knowing that your coverage includes the BlueCard PPO program. The BlueCard PPO program links you directly to care anywhere in the country and in the world. More than 85 percent of all hospitals and physicians throughout the United States participate in the BlueCard PPO national network, along with hospitals in over 40 nations worldwide. Click here to use the BlueCard Doctor and Hospital Finder for participating doctors and hospitals near or at your travel destination, as well as for street maps to their offices.
Q. What do I do in a medical emergency if I am away from home?
A. Horizon Direct Access members are covered for medical emergency care 24 hours a day, seven days a week. If you find yourself in a medical emergency situation, please follow the steps below to receive your care at the in-network level and save on medical costs:
- Go directly to the nearest emergency room or call 911 or your local emergency number.
- Call your Primary Care Physican (PCP) or participating doctor, if possible. In some situations, you may be able to call your PCP or participating doctor before you go to the emergency room. If you can't, please call your doctor within 48 hours. If you are unable to call, have a family member or friend call. It is important that your PCP or participating doctor be kept aware of your condition. Without this information, he/she cannot appropriately coordinate your care and ensure you receive the right care.
Remember to call your PCP or participating doctor. If you don't call your PCP or participating doctor within 48 hours, and it is determined that your visit was not a medical emergency, your medical expenses may not be covered at the in-network level of benefits.
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| Horizon Direct Access FAQs |
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