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You can view your benefits information, including whether you have out-of-network benefits, by signing in and following the steps below:
- Click Benefits & Coverage.
- Click Benefits Overview.
- Select the correct tab - Medical, Dental, Prescription or Vision, as appropriate.
- Scroll down to Plan Details.
- The “Out of Network” column will show in the chart only if you have out-of-network benefits. If you are an OMNIA Health Plan member, you will see tabs for OMNIA Tier 1 and Tier 2.
Important information about out-of-network costs: If an out-of-network doctor or other health care professional charges more than the amount that Horizon BCBSNJ has agreed to pay them (the “allowed amount”) for a service, the doctor or health care professional may bill you for the remaining amount, or the difference. When you are billed for the difference, this is referred to as “balance billing.”
Example: If an out-of-network doctor’s total charge is $100, and the allowed amount (the amount that Horizon BCBSNJ has agreed to pay the doctor for that service) is $70, the doctor may bill you for the remaining $30. You will be required to pay this amount in addition to any copayment, deductible or coinsurance you owe. Refer to your Explanation of Benefit (EOB) statement to see your list of out-of-pocket costs.
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If your health plan includes benefits for out-of-network services or supplies, and you choose to go out of network, you generally will pay more out-of-pocket than if you used in-network providers. In addition, out-of-network providers are not contractually required to accept Horizon BCBSNJ’s reimbursement as full payment for the services and may bill you for the balance of the charges above Horizon BCBSNJ’s reimbursement.
If you do not have out-of-network benefits as part of your plan (i.e. OMNIA Health Plans), you will have to pay the entire amount the provider charged.
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