SEHBP to reconsider behavioral health claim reimbursements

Published on Wednesday, July 9, 2014

Horizon Blue Cross Blue Shield of NJHorizon Blue Cross Blue Shield has announced that it will reconsider certain claims for out-of-network professional behavioral health services, as directed by the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP) commissions.

Reimbursements from Horizon BCBSNJ made between May 4, 2009, and March 23, 2014, are eligible for reconsideration.

Members who are insured through the SEHBP as an active employee or a retiree, and who have received a reimbursement during the designated time period for behavioral health claims for services provided by an out-of-network behavioral health professional, may be entitled to a reconsideration of their claims.

If you have made any such claims and would like to pursue an adjustment, you must be able to show proof that the difference between the Horizon BCBSNJ reimbursement and the provider’s full charge has been paid.

Reconsiderations are not automatic. Members must submit a request form to Horizon BCBSNJ no later than Sept. 30, 2014. For access to the form, and for more information, visit www.state.nj.us/treasury/pensions/bhs-claim-reconsideration.shtml.

Members with questions may contact Horizon BCBSNJ directly at 844-296-1421.


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