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

As our member, you have access to quality care from a large networks of experienced qualified doctors and hospitals. By using the doctors and hospitals in our networks, you can lower your out-of-pocket medical costs and still get the care you need.

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 in-network ambulatory surgical center (ASC) for surgery.

There are two ASCs in Jane’s 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

Charge

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 or hospital near you, 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.