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Helping Your Patients Get the Care They Need

As a doctor or other health care professional, you share a responsibility in helping our members understand their health care status and options. It’s important your patients, our members, have access to the appropriate educational or informational resources they may need so they can get the right care at the right time. We encourage you to ensure that our members have access to services in a manner that honors any health-related cultural beliefs they may have.

Member Rights

Horizon BCBSNJ is committed to respecting our members’ rights to confidentiality, quality of care and service. We encourage our members, to the extent possible, to actively participate in making decisions about their health care and treatment options. Members have a right to:

  • Receive an explanation of their complete medical condition in terms they understand
  • Have full, candid discussions regarding appropriate or medically necessary diagnostic treatment options regardless of cost or benefit coverage
  • Refuse treatment and express preferences about future treatment options

Understanding

It can be difficult for patients to understand their health care. That’s why it’s important you provide your patients with access to the educational and/or informational materials they need in all appropriate language(s) and format(s), if and when required. This includes materials in Braille and in large font type.

You may also need the services of a translator to assist patients who speak another language. According to the National Committee for Quality Assurance (NCQA), Limited English Proficient (LEP) patients who use a professional interpreter have improved patient experiences, comprehension and clinical care.¹ Horizon BCBSNJ members have access to a listing of physicians who speak languages other than English (including the ability to search for the top 20 most spoken languages) in our online Doctor & Hospital Finder.

Members may also contact Horizon BCBSNJ and ask for a Member Services Representative to assist them with locating a physician or other health care professional via our AT&T Language Line. The AT&T Language Line helps our Member Services Representatives communicate with callers in more than 140 languages.

Getting Needed Specialty Care

When your patients require specialty care, encourage them to make appointments with their specialty care doctors or other health care professionals as soon as possible. Many of your patients may not be aware they may have to schedule their appointments at least several weeks in advance. When members make an appointment in advance, it helps to ensure they see specialty doctors in a timely manner.

As a reminder, only patients who have Horizon HMO or Horizon POS plans require referrals for specialty care.

Sharing Lab or Test Results

Your patients often require lab work or other tests. Make sure to schedule a timely follow-up discussion to review their test results with them. Set member expectations so they know when they might hear from your office regarding their blood test, X-ray or other test results.

You can confirm the expected turn-around time for lab results using the Laboratory Corporation of America® (LabCorp) website. LabCorp’s complete menu of services can be accessed by visiting LabCorp.com and then selecting Test Menu.

¹ National Committee for Quality Assurance. Implementing Multicultural Health Care Standards: Ideas and Examples. April 2014.

Published on: February 26, 2018, 13:51 p.m. ET
Last updated on: February 26, 2018, 13:58 p.m. ET