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Division of Pensions & Benefits

Behavioral Health Reimbursement Notice

If you had an out-of-network behavioral health claim between May 4, 2009 and March 23, 2014, you may be eligible for additional reimbursement.

The claims eligible for the reimbursement may include out-of-network sessions with a:

  • Psychologist
  • Licensed clinical social worker
  • Licensed marriage family therapist
  • Licensed professional counselor
  • Clinical nurse specialist

Claims for services from an out-of-network psychiatrist are not eligible for additional reimbursement.

To be eligible for additional reimbursement, you must either show proof or submit a signed certification that you paid the out-of-network provider an amount over and above Horizon Blue Cross and Blue Shield’s reimbursement. This information would not be included in our claim records.

Are you eligible for additional reimbursement?

If you can answer “Yes” to the following questions, you may be eligible. Did you:

  • Submit a behavioral health claim between May 4, 2009 and March 23, 2014, for out-of-network sessions with a psychologist, licensed clinical social worker, licensed marriage family therapist, licensed professional counselor or clinical nurse specialist?
  • Pay the difference between the full charge and the amount previously reimbursed by the plan for the service (coinsurance) or pay additional reimbursement to the behavioral or mental health provider?
  • Confirm that the balance was paid or is still owed, and that any additional reimbursement will be paid to the provider?

You cannot receive reimbursement if:

  • A claim for reimbursement was previously fully paid (between July and December 2014).
  • The provider waived the coinsurance payment.
  • The claim was paid with other coverage, including a Flexible Spending Account or Health Savings Account.

To file a claim for reconsideration, please complete and submit the required form by December 31, 2021 to:

Horizon Blue Cross Blue Shield of New Jersey
P.O. Box 820
Newark, NJ 07101-0820

Visit Horizon for more information.

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Last Updated: Tuesday, 06/01/21