Access to quality care

Choosing a doctor, hospital or health care professional that fits your health care needs is important. Make sure you choose wisely.

We have processes in place to monitor, assess and improve the quality and appropriateness of care the doctors, hospitals and other health care professionals in Horizon BCBSNJ’s networks provide to our members.

We carefully verify the qualifications and background of any doctor or other health care professional who wants to join our network. Our credentialing process is critical to ensuring that our standards of participation and quality are met and adhered to at all times. All doctors and other health care professionals are recredentialed every three years.

Our network is broad, with nearly 24,0001 board-certified doctors. While all doctors in the United States must be licensed to practice medicine, they are not required to be board certified. Board certification is voluntary, and represents a doctor’s commitment to continually expand and refresh his or her knowledge in a particular medical specialty.2

Horizon BCBSNJ also has standards to ensure that our members have access to quality care by participating doctors and other health care professionals. Specialists who perform a high volume of services must be located within a certain geographic area in relation to our members. Standards include:

  • The maximum time or distance a member must travel to see a doctor or other health care professional is generally 30 minutes or 10 miles, whichever is less, from the member’s city/town for Primary Care Physicians (PCPs); and 60 minutes or 45 miles, whichever is less, from the member’s city/town for specialists.
  • The member-to-doctor or member-to-other health care professional ratio. The minimum number of participating doctors or other health care professionals available near the member’s city/town. Ratios vary depending on specialty.

1Numbers current at time of publication. Visit our Doctor & Hospital Finder to find doctors and other health care professionals that participate in our network.

2American Board of Medical Specialties abms.org.

This article is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health provider with any questions you may have regarding a medical condition.