Where Can I Get Care?
Horizon BCBSNJ encourages you to stay in network and choose the right place to get care, so you can save money and time. We have in-network doctors, other health care professionals, laboratories and hospitals throughout New Jersey, and nearby in Pennsylvania and Delaware.
Get the Right Care In the Right Place
Different places to get care
When you need to see a doctor or specialist, we can help you get access to quality care.
Your health condition can often determine where you should go for care. The chart below shows you options for care.
| Retail health clinic | Doctor’s office | Urgent care center | Emergency Room | |
| Animal bites | ✔ | A medical emergency is any medical condition that is so severe, the person’s life may be in danger or it may affect his/her long term health if the person does not get immediate attention. Examples include:
Call 911 or your local emergency services number. Or, go to the nearest Emergency Room. |
||
| Annual wellness/preventive care | ✔ | |||
| Follow up care | ✔ | |||
| Vaccinations | ✔ | ✔ | ✔ | |
| Stiches | ✔ | |||
| Back pain | ✔ | ✔ | ||
| Mild asthma | ✔ | ✔ | ||
| Sprain/strain | ✔ | ✔ | ||
| Nausea/vomiting/diarrhea | ✔ | ✔ | ||
| Burning with urination | ✔ | ✔ | ✔ | |
| Cough/sore throat | ✔ | ✔ | ✔ | |
| Ear/sinus pain | ✔ | ✔ | ✔ | |
| Eye swelling/irritation/redness/pain | ✔ | ✔ | ✔ | |
| Minor allergic reaction | ✔ | ✔ | ✔ | |
| Minor fever/colds | ✔ | ✔ | ✔ | |
| Rash/minor bumps | ✔ | ✔ | ✔ | |
| X-ray | ✔ |
You may have access to a video consult¹ with a doctor for certain health conditions from your computer, smartphone or tablet.
Finding an in-network doctor or hospital
Horizon BCBSNJ has large networks of participating doctors, specialists, other health care professionals, laboratories and hospitals in New Jersey, and nearby in Pennsylvania and Delaware, that take your health insurance plan. When you stay in network, you have access to quality care and you pay less out of pocket. When searching on the Doctor & Hospital Finder, choose your plan name from the drop-down menu before looking for a doctor or hospital. When you download and sign in to the HorizonBlue app², you will easily find doctors near you that accept your plan.
You can search by:
- Type of doctor/specialty (i.e., pediatrician, cardiologist, etc.)
- ZIP code
- Doctor’s last name
- Group or hospital affiliation (many doctors are part of one or more group practices)
And, when you are signed in, you can read reviews from patients who have recently received care from a specific doctor. You can also use the Treatment Cost Estimator tool to help you figure out how much a specific treatment may be.
Lower your costs – stay in network
“Participating” or “in network” means that doctors, other health care professionals, hospitals, laboratories and facilities have joined our Horizon Managed Care Network and/or our Horizon PPO Network and Horizon Hospital Network. Participating doctors and hospitals have agreed to be paid a certain amount based on the care and treatment they provide.
When you get care from a doctor, other health care professional, laboratory or hospital that is in your health plan’s network, you:
1. Save money. You pay less out of pocket when you stay in network. Generally, your copayment, coinsurance and/or deductible, if applicable, are less when you get care and services from in-network doctors and hospitals.
If your health plan offers out-of-network benefits³, and you choose to get care from a doctor or hospital that does not participate in your health plan’s network, you may have to pay the difference between what your plan paid and what the doctor or hospital charged (also known as balance billing).
If your health plan does not include out-of-network benefits, and you choose to get care from a nonparticipating doctor, other health care professional or hospital, you will have to pay the entire bill.
The chart⁴ below shows an example of a member’s out-of-pocket costs for in-network versus out-of-network care.
| Provider's Network | Provider’s charge | Horizon BCBSNJ’s allowance | Jane’s coinsurance or copayment | Horizon BCBSNJ’s payment | Amount Jane pays |
| Out of Network (For members with out-of-network benefits) | $5,000 | $1,500 | $300 Jane pays 20% of the allowance. |
$1,200 Horizon BCBSNJ covers 80% of the allowance. |
$3,800 Jane pays her coinsurance and the difference between the allowance and the provider’s charge. |
| Out of Network (For members without out-of-network benefits) | $5,000 | $0 Horizon BCBSNJ will not pay for any services provided by an out-of-network provider. |
Not applicable. | $0 | $5,000 Jane will have to pay the full amount charged because she doesn't have out-of-network benefits. |
| In Network | $5,000 | $1,500 | $35 This is Jane’s copayment for in-network services. |
$1,465 Horizon BCBSNJ pays the balance up to the allowance. |
$35 Jane only pays her copayment. The provider can't bill her for more than $35. |
2. Save time. All participating doctors and hospitals submit claims directly to Horizon BCBSNJ for processing on your behalf and request prior authorization (pre-approval), if applicable, so you have less to worry about and less paperwork.
Glossary of health insurance words
Confused by the health insurance words and abbreviations? Don’t worry. Horizon BCBSNJ wants to make sure you understand your benefits. Our detailed glossary explains the health insurance terms you need to know to understand your benefits and coverage.
Watch our videos that explain copayments, coinsurance and deductibles.
¹Check your benefits to see if you have coverage for telehealth.
²Data and messaging rates may apply from your mobile carrier.
³Example assumes the member chooses to use an out-of-network doctor, hospital or other health care professional. When a member uses an out-of-network doctor, hospital or other health care professional in a true medical emergency, care is covered at the in-network level of benefits.
⁴Chart is an example for illustrative purposes only. Your benefits and costs may vary.