Why was my claim for services denied for being out of network?
Generally, this means that you went to a nonparticipating doctor and your Horizon BCBSNJ plan does not cover nonemergency services or treatment from out-of-network (nonparticipating) health care professionals. Your Explanation of Benefits (EOB) includes specific information in the Message Codes section about why your claim was denied. To view your EOB, sign in and follow the steps below:
- Click Claims.
- Click Statements of Payment.
- Locate the appropriate claim, and click the claim number hyperlink.
- Click View Explanation of Benefits.
Under the Detail Information field on the EOB, you will see a column listing the Message Codes that apply to the processing of your claim. There will be a full description of your Message Codes explaining why your claim was denied.