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If you see an in-network doctor for care, you only get a medical bill if you owe:

• A copay
• A deductible
• A coinsurance amount
• For services not covered under your plan

When you receive a bill for care, you should review your Explanation of Benefits (EOB). Your EOB tells you what costs are covered for medical care or services you’ve received.

Medical Claims

You can submit out-of-network medical claims by mail or use the Horizon Blue App. This includes claims for behavioral health, prescriptions, eyeglasses, and durable medical equipment like breast pumps, sleep apnea machines, diabetic supplies, orthotics, etc.

Dental Claims

You can submit out-of-network dental claims by mail. Dental claims are not accepted on the Horizon Blue app.

Submitting a Claim

1. Download and complete the appropriate claim form.
2. Include an itemized bill. An itemized bill includes:
   • Patient name
   • Member ID number
   • Date of service
   • Diagnosis code(s)
   • Procedure code(s)
   • Place of service
   • Total charge
3. Submit your claim by mail to the address printed on the form or use the Horizon Blue App.

For Medicare claims, you must include a Medicare Explanation of Benefits (EOB). An Explanation of Benefits (EOB) is the notice that your Medicare Advantage Plan or Part D prescription drug plan typically sends you after you receive medical services or items. You only receive an EOB if you have Medicare Advantage or Part D. An EOB is not the same as a Medicare Summary Notice. It is also important to remember that an EOB is not a bill.

For claims that are sent by mail to Horizon BCBSNJ, there is a 30-day processing period. If the claim you are looking for was mailed within the last 30 days, please allow Horizon BCBSNJ the full time frame for processing.

If it has been over 30 days since you mailed your claim, please call Member Services at the phone number on the back of your member ID card. Depending on your plan, you may also be able to sign in and email or chat with a Member Services Representative.