#Horizon bcbs timely filing plus

Because your doctor has agreed to receive a discounted rate from Horizon BCBSNJ, the total amount your doctor can collect is our contracted payment, plus any applicable coinsurance or copayment from you. For example, if your participating doctor charges $200 for a service, and our allowed amount is $100 for that service, the participating doctor is not permitted to charge you the remaining $100. Participating doctors, dentists, other health care professionals and hospitals are not permitted to “balance bill” you for any difference between their charges and Horizon BCBSNJ's allowed amount for a covered service. Use our Doctor & Hospital Finder to look for a participating doctor, dentist, other health care professional or hospital. Additionally, non-participating providers can balance bill you up to their total charges. If you receive non-emergent services from a non-participating provider, you will have to pay the provider's total charges out of your pocket. There are no out-of-network benefits, except in emergency situations, for Individual consumers enrolled in the Horizon Advantage EPO or OMNIA Health Plans. For eligible dental services to be covered, members must use participating dentists in the dental PPO Network.

Members in the medical plans must use doctors, other health care professionals and hospitals in the Horizon Managed Care Network. Horizon BCBSNJ is also offering three types of dental plans on the Individual Marketplace for 2023 – Horizon Young Grins, Horizon Family Grins and Horizon Family Plus. Horizon BCBSNJ is offering two types of medical plans on the Individual Marketplace for 2023 – Horizon Advantage EPO and OMNIA Health Plans. OUT-OF-NETWORK LIABILITY AND BALANCE BILLING