Getting Care
How to find in-network doctors, healthcare professionals or a hospital
Our HMO plans provide coverage for in-network services only. There is no out-of-network coverage unless your Primary Care Physician (PCP) refers you and the referral is approved by Horizon BCBSNJ. In certain circumstances, out-of-network urgent and emergency care may be covered. The general service area of your HMO plan is the state of New Jersey. To find an in-network doctor, healthcare professional or hospital, use the Horizon Blue app or our Doctor & Hospital Finder.
Remember: Services provided by doctors, other health care professionals, hospitals and facilities that do not participate with your plan are not covered. You’ll be responsible for the total cost of services you get from out-of-network health care providers, except in an emergency.
Choosing a Primary Care Physician
In general, PCPs include licensed family practitioners, general practitioners, internists or pediatricians who have passed our credentialing process. All in-network doctors must meet Horizon BCBSNJ’s credentialing standards. They have agreements with us to participate in the Horizon Managed Care Network. Horizon HMO Access is a plan that uses doctors and other health care professionals in the Horizon Managed Care Network.
- Horizon HMO: Under your Horizon HMO plan, you are required to choose a PCP. If you haven’t done so already, selecting your Primary Care Physician (PCP) is one of the first things you should do. Your PCP is a health care professional who knows your medical history and coordinates your care.
- Horizon HMO Access: When you enroll in Horizon HMO Access, you have the option to choose a PCP or health care professional specializing in obstetrics or gynecology, as the doctor who will provide most of your care.
- Away From Home Care Program: If you haven’t done so already, selecting your PCP is one of the first things you must do. Your PCP is the doctor who will know your medical situation and coordinate your care. Under your Horizon HMO plan through the Away From Home Care Program, you are required to choose a PCP who accepts the Horizon HMO plan.
When you select and use an in-network doctor to coordinate your care, you will pay the lowest copay for your care.
To find a PCP, use the Horizon Blue app or sign in to use the Doctor & Hospital Finder. You can also contact Member Services for help.The doctor you choose as your PCP will handle most of your medical care. He or she will:
- Perform most of your annual wellness and preventive health exams
- Take care of your urgent and emergency care needs when possible
- Refer you to an in-network specialist when medically necessary
- Help coordinate the care you get from other doctors to whom you have been referred
- Give referrals for medically necessary services, when needed
- Be available on call (or appoint a covering doctor), 24/7
Changing your PCP
You are required to make us aware of your PCP selection either online or by phone. You can change your PCP at any time, either online or by phone. To verify that the PCP you chose participates with your plan, use the Horizon Blue app, sign in or call Member Services at 1-800-355-BLUE (2583).
Once you make a change, we will send you a confirmation of your new PCP selection. You may see your new PCP 14 days after notifying us of the change.
Have your medical records transferred to your newly selected PCP. You can do this by completing the Request to Transfer Medical Records form. There may be a cost from your former doctor to transfer your records.
Have a medical question? Call the 24/7 Nurse Line
When you have a medical question and it’s not an emergency, our 24/7 Nurse Line is ready to help at no cost to you.
The 24/7 Nurse Line is available 24 hours a day, seven days a week to help you understand a medical problem, review treatment options, answer questions about medicine, help with questions to ask your PCP and more. Registered nurses will answer your questions and help direct you to the appropriate level of care or provide self-care tips so you can take care of your symptoms at home and feel better faster.
Use the Horizon Blue app or call 1-888-624-3096 24/7 to speak with a nurse. All calls are confidential.
Nurses cannot diagnose problems or recommend specific treatment. They are not a substitute for your doctor’s care. In an emergency, go to the nearest hospital or call 911.
How to Get Help with a Chronic or Serious Health Condition
Our Chronic Care Program helps members who have chronic conditions take better care of their health, understand their care choices and improve their well-being. This program is available at no added cost to eligible members who have:
- Asthma
- Chronic Obstructive Pulmonary Disease (COPD)
- Coronary Artery Disease (CAD)
- Diabetes
- Heart Failure
For more information or to enroll:
- Visit HorizonBlue.com/ccp-enroll.
- Or, call 1-888-334-9006, weekdays, from 8 a.m. to 5 p.m., ET. If you use TTY services, please call 711 during the same hours.
Case Management Program
If you’re diagnosed with a serious medical condition or need major surgery, you may be eligible for our Case Management Program.
Think of your Care Manager as your link to Horizon BCBSNJ, helping you navigate your coverage to get the right care at what could be a difficult, stressful time. Each Care Manager is a registered nurse who is trained to help you review and understand your options for available specialists, hospitals and medical care, while getting the most from your health plan benefits.
What if you become pregnant?
If you become pregnant, Horizon BCBSNJ will be with you and your obstetrician every step of the way, with comprehensive prenatal and maternity coverage.
Horizon BCBSNJ supports the American College of Obstetricians and Gynecologists’ recommendation for 12 obstetrical visits during a normal pregnancy. Your obstetrician will decide how many visits are right for you.
If your obstetrician decides you need more specialized care, you may be referred to a Horizon BCBSNJ Care Manager. Your Care Manager, a registered nurse, will help ensure that you and your unborn baby have the most appropriate care. To learn more about our case management services, please call 1-888-621-5894, option 2.
As an expectant parent, you may have questions and concerns about your pregnancy and delivery. Precious Additions® can help you make healthy and safe choices during this special time with tools and resources. When you enroll in Precious Additions, you will get information about pregnancy, childbirth, the postpartum period and your child’s first year of life.
Maternity Health Coaches are available through the 24/7 Nurse Line. Your Maternity Health Coach will help you throughout your pregnancy so you can feel comfortable about the healthy choices you make for you and your baby.
Behavioral Health Services
Your Horizon HMO Access plan includes coverage for behavioral health services – including mental health and substance use disorder.
The Horizon Behavioral Health℠ care team will help you find the right care through an extensive network of health care professionals and facilities, community organizations and online resources, including access to:
- Substance use treatment programs and recovery support
- Individual and group therapy
- Crisis intervention and mental health treatment
- Coaching programs
- Autism care management services
Out-of-Area Coverage
If you or a covered family member gets sick or injured when outside of New Jersey, you can feel at ease because you have access to the BlueCard® network for care. Without BlueCard, when outside of New Jersey, you are only covered for urgent and emergency care.
