| BlueCard PPO FAQs |
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Questions and answers about the BlueCard PPO program
Q. What is the BlueCard® PPO program?
A. BlueCard PPO is a national program that links participating doctors and hospitals to Blue Cross and/or Blue Shield Plans throughout the United States. So, whether you or a family member is traveling or living in another state, you can take advantage of your benefits by presenting your member ID card to any participating doctor or hospital. Always carry our easily identifiable ID card with a PPO in a suitcase logo, which lists a toll-free number to help you reach a provider.
Q. If I am traveling away from home and require medical care, how does the BlueCard PPO program help me?
A. When you are traveling and need medical care, call the toll-free number on your Horizon BCBSNJ ID card, 1-800-810-BLUE (2583), for names and addresses of the nearest participating BlueCard PPO physicians, health care practitioners, and hospitals. When participating BlueCard PPO physicians, health care practitioners, and hospitals provide your medical care, you receive in-network benefits with low out-of-pocket costs and do not have to file claim forms. Check with your employer or the Horizon BCBSNJ Member Services Department for information about the specifics of your PPO benefit coverage.
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. For your convenience, our Member Services Department is open Monday through Friday, 8 a.m. to 8 p.m., Eastern Standard Time.
Q. What are the advantages of using a participating BlueCard PPO provider?
A. The advantages are low out-of-pocket costs. Your only responsibility is for any applicable copayments or coinsurance and any noncovered expenses. There are no claim forms to file and no balance billing for charges over the Blue Cross and Blue Shield allowance.
Q. How do I find a participating BlueCard PPO provider?
A. Call 1-800-810-BLUE (2583) toll free from any location. (This phone number is printed on your Horizon BCBSNJ ID card.) You may also call the provider's office directly to verify that he/she is a participating BlueCard PPO physician or health care practitioner. You can also find information online via this Web site by selecting the Physician Directory feature.
Q. Will the physician or health care practitioner file my claim?
A. When you use a participating BlueCard PPO physician or health care practitioner, 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 Horizon BCBSNJ ID card. If you are receiving care from a non-BlueCard PPO doctor or hospital, you will have to pay for care upfront and file a claim for reimbursement.
Q. What happens if I use a nonparticipating provider?
A. When you use a nonparticipating provider, you are responsible for paying for care upfront at the time of service. You then submit the bill, along with a completed claim form, for reimbursement. To obtain a claim form, call Horizon BCBSNJ Member Services at 1-800-355-BLUE (2583).
Q. If I choose to see an out-of-network provider, how do I file a claim?
A. When you use a nonparticipating provider, you are responsible for paying for care upfront at the time of service. When going out of network, call Horizon BCBSNJ Member Services at 1-800-355-BLUE (2583) to obtain a claim form. Our representatives can answer any questions about the status or payment of a claim.
Q. Are there services that require pre-authorization?
A. Yes, certain services may require pre-authorization. Check with your employer or Horizon BCBSNJ's Service Department for specifics about what services under your program may require such approval. You or your physician will be 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 Horizon BCBSNJ 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. 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 Horizon BCBSNJ 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. What do I do in a medical emergency if I am away from home?
A. In case of a medical emergency, you should obtain care at the nearest hospital or emergency facility. If the hospital is not in the BlueCard PPO network, don't worry - you will not receive a reduced level of coverage. All actual medical emergency care is paid at the in-network level of benefits, no matter where you may be.
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