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Some in-network medical services are only covered if your doctor or other network provider gets approval in advance. Your primary care physician or specialist may obtain prior authorization for you by calling 1-800-664-2583 (TTY 711).

You can sign in to see what services require prior authorization.

Sign in to find out if you are covered for mental health services. In the Service You May Need menu, select the type of service you are looking for. Mental health services include things like Psychotherapy, Psychiatric-Outpatient, and Cognitive Therapy.

Prior authorization is the written approval from Horizon, prior to the date of service, for a doctor or other health care professional or facility to provide specific services or supplies. It is sometimes called pre-authorization, prior approval or pre-certification. Your Horizon plan may require prior authorization for certain services before you receive them, except in an emergency. Prior authorization isn’t a promise your health insurance or plan will cover the cost. Your participating doctor will work with Horizon to obtain prior authorization.

Visit the Blue Cross® Blue Shield® National Doctor and Hospital Finder to find an in-network doctor or hospital nationwide.

To find an in-network durable medical equipment supplier, visit our Doctor & Hospital Finder and choose Medical for the type of care you are looking for. After you choose your plan and enter a location to search in, you can type Durable Medical Equipment Supplier.

Find out if you have coverage for DME by signing in and following these steps:

1. Click Benefits & Coverage.
2. Click What’s Covered.
3. Under the Medical tab, go to the dropdown menu titled Services you may need. Select Durable Medical Equipment, Durable Medical Equipment Purchase, or Durable Medical Equipment Rent, and click Show Coverage Details. Note: Some DME can be rented, while others must be purchased. The decision to rent or purchase depends on several factors, including, but not limited to, the type of equipment, length of need and information provided by your doctor.
4. Check the chart(s) to see if the benefit is covered, how much your plan will pay, and if prior authorization is required. You may need to scroll down to view all the information you need.

Durable Medical Equipment, or DME, is equipment or supplies that help you at home. They are usually ordered by your doctor when you have certain medical conditions or illnesses.

Examples of DME include:

• breast pumps
• sleep apnea machines
• diabetic supplies like blood testing strips and monitors
• orthotics
• prosthetics
• wheelchairs
• hospital beds
• oxygen tanks

Sign in to view your coverage information. Then, select the coverage type to see your plan details.

If this information needs to be updated:

If you have coverage through your employer: Contact your employer’s benefits administrator or human resources department directly.

If you purchased your coverage directly from Horizon: Call Horizon at the phone number on the back of your ID card.

If you purchased coverage through the NJ State Based Exchange (SBE): Contact Get Covered New Jersey or call Horizon at 1-800-224-1234.

No-cost flu shots are available to members enrolled in a Horizon medical plan.

To get a no-cost flu shot, you must go to one of the following locations or you can see your in-network doctor:

• ACME Savon Pharmacies
• MinuteClinic® at select CVS locations
• Rite Aid
• ShopRite
• Walgreens
• Wegmans

September and October are generally good times to be vaccinated against flu, before it begins spreading.

It’s important to get a flu shot as soon as it becomes available, so that the vaccine is most effective and protects you throughout the flu season. While the flu can spread year-round, most of the time flu activity peaks between December and February, but activity can last as late as May.

Visit the CDC website for more information about preventing seasonal flu.