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Behavioral Health Reimbursement Notice

If you or a covered dependent had an out-of-network behavioral health claim while a member with health coverage through the SHBP/SEHBP between May 4, 2009 and March 23, 2014, you may be eligible for additional reimbursement.

The State Health Benefits Program and School Employees’ Health Benefits Program has directed us to notify members who may have been reimbursed for out-of-network behavioral health claims during this specific period. The claims eligible for the reimbursement may include out-of-network sessions with a:

  • Psychologist
  • Licensed clinical social worker
  • Licensed marriage family therapist
  • Licensed professional counselor
  • Clinical nurse specialist

Claims for services from an out-of-network psychiatrist are not eligible for additional reimbursement.

To be eligible for additional reimbursement, you must either show proof or submit a signed certification that you paid the out-of-network provider an amount over and above the reimbursement you originally received. This information would not be included in our claim records.

Are you eligible for additional reimbursement?

If you can answer yes to the following questions, you may be eligible. Did you:

  • Submit a behavioral health claim between May 4, 2009 and March 23, 2014, for out-of-network sessions with a psychologist, licensed clinical social worker, licensed marriage family therapist, licensed professional counselor or clinical nurse specialist?
  • Pay the difference between the full charge and the amount previously reimbursed by the plan for the service (coinsurance) or pay additional reimbursement to the behavioral or mental health provider?
  • Are you still being billed by the provider for the charges?

You cannot receive reimbursement if:

  • A claim for reimbursement was previously fully paid (between July and December 2014).
  • The provider waived the coinsurance payment.
  • The claim was paid with other coverage, including a Flexible Spending Account or Health Savings Account.

How to file a claim

To file a claim for reconsideration, please complete and submit the Request for Adjustment of Out-of-Network Behavioral Health Claims form by December 31, 2021 to:

Horizon Blue Cross Blue Shield of New Jersey
PO Box 820
Newark, NJ 07101-0820

If you need information about the dates of service, provider contact information, the amount billed from provider and the amount reimbursed, complete and submit the Request for Information – Out-of-Network Behavioral Health Claims form.

Questions?

Email SHBP_bhreimbursement@HorizonBlue.com if you have questions or need help completing the forms.

If you do not have access to email, please call 1-866-660-7223, weekdays between 8 a.m. and 4 p.m., Eastern Time.