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 OMNIA℠, 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.