How do I file an appeal? I don't agree with Horizon's decision on my claim.
You can appeal our decision. To file an appeal, your request must be made in writing and include the following information:
- Member name and address
- Member ID number
- Patient’s name and address (if different from member)
- Provider of service
- Date(s) of service
- Claim number(s)
- Reason for appeal
Your appeal must be filed within one year of your receipt of the Explanation of Benefits (EOB) statement.
Your duly authorized representative, your doctor or other health care professional acting for you and with your consent can also file an appeal.
You will not be disenrolled, discriminated against or penalized if you submit an appeal.
For general health claims, except for members of the New Jersey State Health Benefits Program (SHBP), School Employees’ Health Benefits Program (SEHBP), Medicare Advantage or Medicare Supplement plans, send your appeal to:Horizon BCBSNJ
Attn: Appeals Coordinator
PO Box 317
Newark, NJ 07101-0317
New Jersey State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) Members
For members enrolled in the New Jersey State Health Benefits Program (SHBP) and School Employees’ Health Benefits Program (SEHBP), refer to your Member Guidebook on the Division of Pensions & Benefits site for information on how to file an appeal.
Medicare Advantage Plan Members
Mail claim appeals requests and complaints about medical care to:Horizon Medicare Advantage
3 Penn Plaza East, PP-12L
Newark, NJ 07105-2200
Medicare Supplement Plan Members
If you are questioning a claim denial, send a written request regarding the claim to the following address:Horizon BCBSNJ
PO Box 420
Newark, NJ 07101
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