The Horizon Hospital Network is one of the largest hospital networks in the region.

When you use one of these hospitals, you may be admitted by either a participating or nonparticipating physician. Your Primary Care Physician or participating specialist will arrange for you to receive inpatient or outpatient hospital care and services, when medically necessary.

You can choose to lower your out-of-pocket hospital or facility expenses by:

• Following our prior authorizations procedures discussed in Tip #8, "Get a referral and prior authorization (if required) before you receive specialty care."
• Receiving care from a participating hospital or other participating health care facility.

Please note: If you have not obtained the necessary prior authorization and received care at a nonparticipating hospital, your care will be considered out of network and you will pay more out of your pocket. Also, if your doctor is nonparticipating, claims for physician services related to your prior authorized hospitalization are considered out of network.

You can review the Horizon Hospital Network in your Horizon BCBSNJ Directory of Participating Physicians and Other Health Care Professionals, or at the Online Provider Directory. If you need further assistance, please call Member Services.

A Hospital Stay and Prior Authorization

If you are hospitalized, your doctor must contact us for prior authorization for your services to be covered at the in-network level. If your care is rendered by a nonparticipating doctor, you must call Member Services to obtain prior authorization for services rendered.

Emergency Hospital Admissions

If you are admitted to a hospital through the emergency room, you do not need a referral form. However, please call or have your authorized representative call your PCP as soon as reasonably possible, so that he/she is aware of your condition and can coordinate your care.