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Questions and answers about the BlueCard PPO program
Q. What is the BlueCard® PPO program?
A. BlueCard PPO is a national program that links participating doctors and hospitals to Blue Cross and/or Blue Shield Plans throughout the United States. So, whether you or a family member is traveling or living in another state, you can take advantage of your benefits by presenting your member
ID card to any participating doctor or hospital. Always carry our easily identifiable
ID card with a PPO in a suitcase logo, which lists a toll-free number to help
you reach a provider.
Q. I am not yet an enrolled member but am considering enrolling. Where do I call?
A. Please use the Horizon BCBSNJ Pre-Enrollment Hot Line:
1-800-722-BLUE (2583). This line is specifically set up to accommodate individuals not yet enrolled
with Horizon BCBSNJ. When calling, simply specify the name of your employer, so we can access information
about your plan. Once enrolled, members will have access to our dedicated Member Services Department. The
Member Services number is 1-800-355-BLUE (2583). Please only use the Member Services
line if you are an enrolled member.
Q. If I am traveling away from home and require medical care, how does the BlueCard PPO program help me?
A. When you are traveling and need medical care, call the toll-free number on your
Horizon BCBSNJ ID card, 1-800-810-BLUE (2583), for names and addresses of the nearest
participating BlueCard PPO physicians, health care practitioners, and hospitals. When participating
BlueCard PPO physicians, health care practitioners, and hospitals provide your medical care, you receive
in-network benefits with low out-of-pocket costs and do not have to file claimforms. Check with your
employer or the Horizon BCBSNJ Member Services Department for information about the specifics of your PPO benefit coverage.
Q. Who do I call for customer service?
A. Call Horizon BCBSNJ's dedicated Member Services Department at
1-800-355-BLUE (2583) for any service or claim issue.
You can also call this number to obtain claim forms or claim submission information.
For your convenience, our Member Services Department is open Monday through
Friday, 8 a.m. to 8 p.m., Eastern Standard Time.
Q. What are the advantages of using a participating BlueCard PPO provider?
A. The advantages are low out-of-pocket costs. Your only responsibility is for any applicable copayments or coinsurance and any noncovered expenses. There are no claim forms to file and no balance billing for charges over the
Blue Cross and Blue Shield allowance.
Q. How do I find a participating BlueCard PPO provider?
A. Call 1-800-810-BLUE (2583) toll free
from any location. (This phone number is printed on your Horizon BCBSNJ ID card.)
You may also call the provider's office directly to verify that he/she is a
participating BlueCard PPO physician or health care practitioner. You can
also find information online via this
Web site by selecting the Physician Directory feature.
Q. Will the physician or health care practitioner file my claim?
A. When you use a participating BlueCard PPO physician or
health care practitioner, he/she files claims for you. Horizon BCBSNJ's Member
Services representatives can answer any questions about the status or payment
of a claim. The toll-free Member Services number is on your Horizon BCBSNJ
ID card. If you are receiving care from a non-BlueCard PPO doctor or hospital,
you will have to pay for care upfront and file a claim for reimbursement.
Q. What happens if I use a nonparticipating provider?
A. When you use a nonparticipating provider, you
are responsible for paying for care upfront at the time of service.
You then submit the bill, along with a completed claim form, for reimbursement.
To obtain a claim form, call Horizon BCBSNJ Member Services at
1-800-355-BLUE (2583).
Q. If I choose to see an out-of-network provider, how do I file a claim?
A. When you use a nonparticipating provider, you are responsible for paying for
care upfront at the time of service. When going out of network, call Horizon BCBSNJ Member Services
at 1-800-355-BLUE (2583) to obtain a claim form. Our representatives can answer any
questions about the status or payment of a claim.
Q. Are there services that require pre-authorization?
A. Yes, certain services may require pre-authorization. Check with your employer
or Horizon BCBSNJ's Service Department for specifics about what services under your program may require
such approval. You or your physician will be required to contact Horizon BCBSNJ's Care Management
Department at the number on your ID card to obtain pre-authorization.
Q. How do I obtain pre-authorization for other services from Horizon BCBSNJ?
A. Your Horizon BCBSNJ ID card lists a toll-free number for pre-authorization. It
is your responsibility to obtain pre-authorization when it is required. Without pre-authorization, there
may be a reduction in benefits or no benefits may be paid, depending on the terms of coverage.
Q. My children are attending college in another state. Are they still covered under my health plan?
A. When your children go off to college, their health care benefits travel with them. With BlueCard PPO, students don't have to worry about filing complicated claim forms or dealing with billing hassles. They simply need to present their Horizon BCBSNJ ID card before receiving care from a participating provider and pay any applicable copayments. BlueCard PPO takes care of the rest. They can use any BlueCard PPO provider in the state where they are residing just as they would if they were home with you.
Q. Is it easy for my children attending college in another state to find a participating provider?
A. The BlueCard PPO program provides established
health care networks to more than 95 percent of the United States population.
Members enjoy access to the largest health care network in the nation,
featuring over 6,000 participating hospitals and more than 600,000
participating physicians, specialists, and subspecialists.
To locate the names and addresses of participating practitioners
in their area, students can call 1-800-810-BLUE (2583).
Students can also use this Web site to locate providers online.
Q. What do I do in a medical emergency if I am away from home?
A. In case of a medical emergency, you should obtain
care at the nearest hospital or emergency facility. If the hospital is not
in the BlueCard PPO network, don't worry — you will not receive a reduced
level of coverage. All actual medical emergency care is paid at the
in-network level of benefits, no matter where you may be.
Q. How do I enroll with BlueCard PPO?
A. How you enroll will vary based on your employer.
Please contact the Pre-Enrollment Hot Line at 1-800-722-BLUE (2583), so we may
assist in directing you. You may also contact your employer's Human Resources personnel.
Q. What if I have additional coverage aside from my BlueCard PPO benefits, like dental or prescription drug benefits? How do I obtain information about those programs?
A. You may be eligible for other benefits programs, like dental, prescription
drugs, or even flexible spending. Who administers these programs will vary based
on your employer. Visit the Horizon BCBSNJ Links option on this
Web site to obtain information about these other coverage options,
if administered by Horizon BCBSNJ. If you are an enrolled member, contact
Member Services at 1-800-355-BLUE (2583) for information
about other programs. If you are not yet enrolled, contact the Pre-Enrollment Hot Line at 1-800-722-BLUE (2583) for assistance.
Q. What is CareAdvantage ®'''?
A. CareAdvantage is a medical management services company that has
historically provided utilization management and case management services
for our Indemnity and PPO lines of business.
Q. Why are we making this transition, and what does it involve?
A. This transition involves Horizon BCBSNJ assuming all utilization
management and case management functions for the Indemnity and PPO lines of
business previously handled by CareAdvantage, reflecting our desire to have
one face to our members, providers, and accounts.
Q. Are there new telephone numbers that will replace the
CareAdvantage numbers?
A. The following telephone number will be used for all
utilization management and case management services for our Indemnity and PPO
lines effective January 1, 2003: 1-800-644-BLUE (2583).
Q. When did this change take effect?
A. January 1, 2003.
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