Horizon Blue Cross Blue Shield New Jersey for Addiction Treatment

Horizon Blue Cross Blue Shield of New Jersey was founded in 1932 and offers health insurance plans to New Jersey residents and businesses. They also financially support organizations in their communities.

You can get individual and family plans through your employer or the New Jersey Marketplace. Horizon also offers Medicaid and Medicare plans. Overall, the company covers over 3.8 million people.

What Does Horizon Blue Cross Blue Shield Cover?

They cover medical and pharmacy services and vision and dental care. Their casualty services division also manages workers’ compensation claims. They have a New Jersey Medicaid plan and a couple of Medicare Advantage plans. Coverage through Medicare Advantage varies depending on your age and the county you live in.

Does Horizon Blue Cross Blue Shield of New Jersey Cover Drug Rehab?

Most Horizon plans will offer at least some coverage for drug rehab. There’s a federal law called the Affordable Care Act (ACA) that requires almost all long term plans to cover 10 essential health benefits, which include mental health and addiction treatment.

However, there are some exceptions to the law and the level of coverage will depend on your specific Horizon BCBS of New Jersey plan. You may have to use a treatment center that’s in your plan’s provider network. Fortunately they make it easy to see which providers are in the plan’s network.

You will want to work with your doctor to create a treatment plan which will be used to determine what’s medically necessary for your situation. Your doctor can also provide you with a referral or call for preauthorization if required before you begin treatment.

What Types of Plans Do They Have?

Horizon BCBS of New Jersey offers a wide variety of plans. You can get individual or family plans through the Insurance Marketplace or your employer, and you can get Medicaid or Medicare insurance if you qualify.

For individual and family plans, there are four primary formats of insurance. They are preferred provider organizations (PPO), health maintenance organizations (HMOs), point of sale plans (POS), and exclusive provider organizations (EPOs).

A PPO has a higher monthly premium but gives you the most flexibility. You can see specialists like therapists or addiction counselors without a referral, and you can get at least some coverage for out of network providers. A POS also has some coverage for out of network professionals but you have to get referrals for specialist care.

An HMO and EPO do not provide out of network coverage. An HMO is usually the least expensive insurance plan, and it requires you to get referrals for specialist care from your primary care provider. An EPO doesn’t require referrals.

Horizon BCBS of New Jersey also offers Medicare plans to those who qualify. If you have Original Medicare, you can get your Part D prescription drug plan from Horizon and you can also purchase a Medicare supplement plan as well. Another option is to get Medicare Advantage, which entirely replaces Original Medicare and can provide additional benefits, such as prescription drug coverage, vision and dental care, gym memberships, and more.

Lower income individuals and families may have Horizon BCBS of New Jersey plan through the NJ FamilyCare Medicaid program. These state sponsored plans offer coverage for a broad range of care, including mental health and substance use treatment. You don’t need referrals to see specialists and your out of pocket costs are low or even $0.

Is Horizon Blue Cross Blue Shield Accredited?

Some of Horizon’s plans are accredited by the NCQA. This includes all their commercial plans and some of the plans they offer on the New Jersey health exchange. The plans they offer on the exchange that are accredited are the PPO and EOS type plans.

Accreditation is important because it tells you that the plan meets quality standards. Plans have to show that their network has enough providers and that they don’t refuse appropriate coverage to earn this accreditation.

Does Horizon BCBS of New Jersey Cover Other Mental Healthcare?

Most insurance plans cover mental healthcare, thanks to the 2010 Affordable Care Act. It’s important to check your coverage for exceptions and determine if your mental healthcare treatment program is covered. Most Horizon plans have some coverage for addiction care, and treatment for co-occurring mental health disorders is common within addiction rehab programs.

A co-occurring disorder is when a person is suffering from addiction alongside another mental health issue. You can likely use your Horizon plan to seek integrated care to address both issues at once.

What Inpatient Addiction Treatment Does Horizon BCBS of New Jersey Cover?

Medically necessary care is at the core of your insurance coverage. When you get a treatment plan from your doctor, you can verify the coverage by contacting Horizon BCBS of New Jersey.

Inpatient addiction treatment is common for patients who have co-occurring disorders, and inpatient care may also involve medical detox, which is always done under the close supervision of a doctor.

If your doctor determines that you need inpatient or residential treatment after detox, you may be in a program that lasts between 30 and 90 days. You’ll live at the facility and receive focused care.

What Outpatient Rehab Does Horizon BCBS of New Jersey Cover?

There are typically three types of outpatient rehab: PHP, IOP, and general outpatient care.

A PHP, or partial hospitalization program, typically requires patients to attend treatment for several hours per day and multiple days per week.

An IOP is an intensive outpatient program that steps down in intensity from PHP but is still more intensive than a typical once-weekly general outpatient program. An IOP is usually designed for patients who have already completed a PHP or require less intensive treatment.

Does Horizon BCBS of New Jersey Cover Methadone & Suboxone (MAT)?

Medically-assisted treatment (MAT) is sometimes a good option for patients with opioid addiction. Methadone and suboxone are two FDA-approved medications that can help reduce withdrawal symptoms and block the cravings for opioids.

Methadone and suboxone act on the brain the same way as opioids but without the high. Suboxone combines two drugs, naloxone and buprenorphine. Both methadone and suboxone can be effective for opioid addiction, but methadone is typically easier for flexible dosing to avoid relapse.

How to Verify Coverage With Horizon BCBS of New Jersey

You can verify coverage with Horizon BCBS of New Jersey by contacting the customer service number. You can also log into your online member account for your plan and check there.

If you already have a treatment center you’re interested in, you can ask them to verify coverage and find out if they accept your current plan. It’s important to ensure you use your exact plan name to verify coverage and not just the company name. There are a wide variety of plans and not all of them may cover what you need.