Horizon BCBS of NJ Help Please

UGH! I am so frustrated! I've been trying to get a claim paid since September 2014. It IS a covered service according to my plan, and my provider is authorized to perform the service. Each time I call and reach a claims "specialist", they give me a different reason why it has been rejected, and different advise on what to do next. The last two reasons are that 1) the code is wrong, and or 2) it is a medical rather than behavioral health claim. I've even had my provider call, and afterwards, they told her that it was cleared up and ready to pay (it was not). Is there someone out there that knows someone I could talk to, or that I could correspond via email with? I need to speak to someone who actually knows what to do and how to do it.

Thank you in advance!


If the insurance was obtained through your (or a family member's) employer, explain the problem to that employer's employee benefits person and ask for their assistance. Same procedure if insurance is through a union. If this is an individual policy and you bought it through a broker, the broker may be able to advise on how to proceed.


File a complaint with the state insurance board. When I had an HMO with Horizon, they rejected EVERY claim, even routine things like annual physical. They rejected EVERY appeal. So I stopped appealing would just write the state insurance board. The claim was paid quickly after that...EVERY time.


If you still have a yellow pages, the address should be on top of the insurance section. Otherwise you should be able to find it online. They probably have an online complaint form.


Here you go: http://www.state.nj.us/dobi/consumer.htm

File a complaint online or just call them. It will be worth your effort!


You could also contact Karin Price Mueller, the Bamboozled columnist at the Star Ledger. She's easily reachable via email (kmueller@starledger.com). If she chooses to fight your battle in her column, Horizon may pay your claim before they get the bad publicity.



Infoseeker said:
You could also contact Karin Price Mueller, the Bamboozled columnist at the Star Ledger. She's easily reachable via email (kmueller@starledger.com). If she chooses to fight your battle in her column, Horizon may pay your claim before they get the bad publicity.

This is a really good idea, Ihave an ongoing reimbursement issue with medical ins. and plan on contacting Bamboozled soon is it isn't worked out.


bamboozled probably gets thousands of requests and only takes a few...you can always try...but they pick the ones that make the best stories


I agree. Getting help from bamboozled is a long shot in even getting selected. I would file the complaint if I were you.


Another approach is to write to the president of Horizon BC/BS who is, according to its website, Robert Marino. I suggest a registered letter that outlines your problems and requests an answer in three days. In most large firms, this becomes an assigned, prioritized issue that tracked until resolved. You will probably get a follow up call or letter pretty promptly. Also you should add something in the letter about going to the state regulator etc. for added ommph.



risayes said:
I've even had my provider call, and afterwards, they told her that it was cleared up and ready to pay (it was not).

Did they get a reference number from that call?



dianaid said:
Another approach is to write to the president of Horizon BC/BS who is, according to its website, Robert Marino. I suggest a registered letter that outlines your problems and requests an answer in three days. In most large firms, this becomes an assigned, prioritized issue that tracked until resolved. You will probably get a follow up call or letter pretty promptly. Also you should add something in the letter about going to the state regulator etc. for added ommph.

That's true but you shouldn't have to state you're going to a regulator. Implied threats are not appreciated at that level.

Its best to state your case - this is what happened (point out everything), that I was told this but what I was told did not happen. I'm frustrated and I really would appreciate you or your office help to resolve this dilemma.

When an executive office gets a polite complaint/request the request is sent to the applicable manager for resolution. That manager is told "let us know how this works out." It motivates the manager and the office working on the case to do a thoroughly complete job.


Billing problems are really the providers problem, not yours (assuming they're an in network provider). My doctor miscoded several procedures, and because it took more than the allowed time (90? 120? Days) the claim was no longer eligible to be paid. The provider had to eat the $$.


I have also heard of people tweeting complaints to a company and getting results



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