Lower your out-of-pocket expenses by staying in network

As a Horizon BCBSNJ member, you have access to a large network of qualified doctors, hospitals and other health care professionals. And by using doctors, hospitals and other health care professionals in our network you can save money on your out-of-pocket medical costs.

If you choose to use your out-of-network benefits1, you will pay more of the costs. Your out-of-network costs may include a higher deductible, coinsurance and/or copayment. Also, you pay the difference between the charges Horizon BCBSNJ has agreed to pay (allowance2) and the actual charge by the out-of-network provider for the service (billed amount).

Let’s look at how Jane saves money when she uses an ambulatory surgical center (ASC) that’s in network.

Jane will have surgery at an ASC. There are two ASCs in her area. One is in Horizon BCBSNJ's network, and the other is not. Her health plan pays in-network and out-of-network services differently:

ASC center


Horizon  BCBSNJ’s  allowance

Jane’s coinsurance or  copayment

Horizon BCBSNJ’s payment

What Jane pays

Out of  network $5,000 $1,500 $300 $1,200 $3,800
      Jane pays 20 % of the allowance for out-of-network services. Horizon BCBSNJ covers 80 % of the allowance for out-of-network services. Jane pays the coinsurance and the difference between the allowance
In  network $5,000 $1,500 $35 $1,465 $35
      Jane pays her $35 copayment for in-network services. Horizon BCBSNJ is responsible for the balance  up to the allowance. Jane pays only her copayment. The ASC cannot bill Jane for more  than her $35 copayment.
By using an in-network ASC, Jane saves $3,765.          

To find an in-network doctor, hospital or other health care professional in your area, visit our Doctor & Hospital Finder.

To learn about your benefits, claims, authorizations and/or referrals, sign in to Member Online Services.

1Members enrolled in OMNIASM, Horizon HMO, Horizon Advantage EPO, and Horizon Advantage EPO Essentials plans do not have out-of-network benefits.

2Allowance is an amount Horizon BCBSNJ has agreed to reimburse its members for covered services and supplies. The allowance may be less than the doctor’s charge. In-network doctors have agreed to accept the allowance minus the member’s cost-sharing responsibility, when applicable. Out-of-network doctors have not agreed to accept the allowance and will bill a patient for the full charge of the service.