UNITE HERE HEALTH

Horizon BCBSNJ provides coverage to certain groups within UNITE HERE HEALTH (UHH), a multi-employer benefit trust fund serving the hospitality, food service and gaming industries.

Below is a list of the procedures/services that require prior authorization (PA) for members enrolled in the following UHH groups.

• UHH Group # 76141 - Atlantic City
• UHH Group # 76215 - New York
• UHH Group # 76315 - New York
• UHH Group #76275 - Food Service Plan 376
• UHH Group #76305 - Food Service Plan 176
• UHH Group #76306 - Food Service Plan 176
• UHH Group #76307 - Food Service Plan 376

This list was revised on March 1, 2021, and may be subject to change.

• Air Ambulance Transportation – NON-EMERGENT


• Bariatric or Gastric Bypass Procedures – Surgery for Morbid Obesity, including but not limited to, Bariatric Procedures, Gastroplasty, Gastric Bypass - outpatient


• Cardiac Radiology Services – non-emergent only Please note that only the following Cardiology Imaging Services require PA by eviCore healthcare for these members. (Visit the Cardiology Imaging Program webpage or call eviCore healthcare at 1-866-496-6200)
  • Stress testing (Myocardial perfusion imaging [SPECT and PET], Stress echocardiography)
  • Cardiac CT and MRI
  • Echocardiography: transthoracic and transesophageal
  • Diagnostic heart catheterization


• Clinical Trials


• Cosmetic Procedures and Potentially Cosmetic Procedures, including, but not limited to, cosmetic dermatology services, varicose vein procedures


• Durable Medical Equipment (DME) - certain DME items costing over $500 (Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321)


• Gender Reassignment


• Habilitative therapy for children with autism spectrum disorder (ABA therapy) (Call HealthCheck360 at 1-844-462-7812)


• Home Health Care Services – all skilled services in the home


• Home Hospice Services


• Home Infusion Services (Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321)


• Hyberbaric Oxygen Therapy


• Inpatient Admissions
  • Medical admissions
  • Surgical admissions
  • Hospice admissions (exclusive of maternity delivery)
  • Rehabilitation facility admissions (acute rehab, skilled nursing and sub-acute)
  • Mental health and substance abuse admissions (call Horizon Behavioral Health at 1-800-626-2212)


• Medical Foods


• Mental Health and Substance Abuse Services (call Horizon Behavioral Health at 1-800-626-2212)
  • Inpatient (IP)
  • Inpatient Detox
  • Residential (RTC)
  • 23hr Bed
  • 72hr Bed
  • Partial Hospitalization (PHP)
  • Intensive Outpatient (IOP)
  • Psychological Testing
  • In-Home Services
  • Electroconvulsive Therapy (ECT)
  • Transcranial Magnetic Stimulation (TMS)


• Molecular and Genomic Testing services (Visit the Molecular and Genomic Testing Program webpage or call eviCore healthcare at 1-866-496-6200)


• Prosthetics/Orthotics - over $500 (Visit the Horizon Care@Home webpage or call CareCentrix at 1-855-243-3321)


• Radiation Therapy services (Visit the Radiation Therapy Program webpage or call eviCore healthcare at 1-866-242-5749)


• Radiology/Imaging Services, including but not limited to the following. (Visit the Radiology/Imaging Services webpage or call eviCore healthcare at 1-866-496-6200)
  • Magnetic Resonance Imaging (MRI)
  • Magnetic Resonance Angiograms (MRAs)
  • Positron Emission Tomography (PET) scans
  • Positron Emission Tomography – Computed Tomography (PET-CT)
  • Computerized Tomography (CT) scans
  • Computed Tomography Angiography (CTA) scans
  • Nuclear Medicine
  • Nuclear Cardiac Imaging


• Specialty Pharmaceuticals/Medical Injectable Drugs (e.g., Botox, IVIG, Flolan and derivatives, Xolair) (Visit the Medical Injectables Program webpage or call Magellan Rx Management at 1-800-424-4508)


• Transplant Services, except Corneal Transplants (Case Management)


• Travel and Lodging benefits (call UHH at 1-833-637-3519)