How can we help?

Find out if you are covered for mental health services by following these steps:

1. Select Benefits & Coverage, then What’s Covered.
2. Under the Medical tab, go to the dropdown menu titled Service you may need.
3. Select the type of service you are looking for, such as Psychotherapy, Psychiatric-Outpatient, or Cognitive Therapy. Then, select Show Coverage Details.
4. Check the chart(s) to see if the benefit is covered, how much your plan will pay, and if prior authorization is required. You may need to scroll down to view all of the information you need.

To find an in-network mental health provider in New Jersey, visit the Horizon Behavioral Health website.

To find an in-network mental health provider nationwide, visit the Blue Cross® Blue Shield® National Doctor and Hospital Finder.

Visit the Horizon Behavioral Health website to find an in-network behavioral health provider.

To find an in-network behavioral health provider nationwide, visit the Blue Cross® Blue Shield® National Doctor and Hospital Finder.

The easiest way to submit out-of-network mental health and SUD claims is through the Horizon Blue app. When you use the Horizon Blue app, you don’t need to submit a claim form by mail.

When you submit out-of-network mental health and SUD claims by mail, you will need to include the appropriate claim form listed below and mail it, and the required information listed on the form, to the address on the form:

• Merck members: Merck Health Insurance Claim Form
• Organon members: Organon Health Insurance Claim Form
• State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
• All other members: Horizon Health Insurance Claim Form

You can appeal our decision on your mental health or substance abuse claim. To file an appeal, your request must be made in writing and include the following information:

• Member name and address
• Member ID number
• Patient’s name and address (if different from member)
• Provider of service
• Date(s) of service
• Claim number(s)
• Reason for appeal

Your appeal must be filed within one year of your receipt of the Explanation of Benefits (EOB) statement.

Your duly authorized representative, your doctor or other health care professional acting for you and with your consent can also file an appeal.

You will not be disenrolled, discriminated against or penalized if you submit an appeal.

For mental health and substance abuse claims, except for Medicare Supplement plans, send your appeal to:

Horizon BCBSNJ
Attn: Behavioral Health Appeals
PO Box 10191
Newark, NJ 07101-3189

For mental health and substance abuse claims for Medicare Supplement plans, send your appeal to:

Appeals Department
Horizon Blue Cross Blue Shield of New Jersey
P. O. Box 317
Newark, NJ 07105

View your benefits to see a mental health professional by following these steps:

1. Select Benefits & Coverage, then What’s Covered.
2. Using the Coverage dropdown menu, select the active medical account.
3. Under the Medical tab, go to the dropdown menu titled Service you may need.
4. Select the type of service you are looking for, such as Psychotherapy, Psychiatric-Outpatient, or Cognitive Therapy. Then, select Show Coverage Details.
5. Check the chart(s) to see if the benefit is covered, how much your plan will pay, and if prior authorization is required. You may need to scroll down to view all of the information you need.

To find an in-network mental health provider, use the Doctor & Hospital Finder.

Behavioral health services, including mental health and substance abuse services, will never require a referral.

For other services, some plans require you to get a referral from your Primary Care Physician before you see a specialist.

For more information on which specific services require a referral to see a specialist, the following options may be available to you:

1. To view plan documents, select Document Center, then Benefits & Coverage. From there, some members¹ may be able to access their Summary of Benefits & Coverages (SBC) and search for “referral.”
2. Use our Email Us or Chat tools and select Benefits to ask a Member Services Representative if the service requires a referral.

View your benefits for substance abuse services by following these steps:

1. Select Benefits & Coverage, then What’s Covered.
2. Using the Coverage dropdown menu, select the active medical account.
3. Under the Medical tab, go to the dropdown menu titled Service you may need.
4. Select the type of service you are looking for, such as Substance Abuse, Substance Abuse Facility – Inpatient, or Substance Abuse Facility – Outpatient. Then, select Show Coverage Details.
5. Check the chart(s) to see if the benefit is covered, how much your plan will pay, and if prior authorization is required. You may need to scroll down to view all of the information you need.

To find an in-network substance abuse doctor, hospital or other healthcare professional, use the Doctor & Hospital Finder.

When you submit out-of-network mental health and substance use disorder (SUD) claims through your account using our website or the Horizon Blue app, you don’t need to submit a claim form by mail. Simply select Claims, then Submit a Claim.

When you submit out-of-network mental health and SUD claims by mail, you will need to include the appropriate claim form listed below and mail it, and the required information listed on the form, to the address on the form:

• Merck members: Merck Health Insurance Claim Form
• Organon members: Organon Health Insurance Claim Form
• State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
• All other members: Horizon Health Insurance Claim Form