
With Horizon BCBS Direct Access, you get direct access to quality healthcare providers in your network. This means you can see a doctor or specialist without a referral, making it easier to get the care you need.
Horizon BCBS Direct Access offers a network of over 70,000 healthcare providers, including primary care physicians and specialists. You can find a provider near you using the Horizon BCBS Direct Access online tool.
By having direct access to quality healthcare providers, you can get the care you need quickly and efficiently. This can be especially helpful if you have a non-emergency medical issue that needs attention.
Horizon BCBS Direct Access also provides access to telehealth services, allowing you to consult with a doctor or specialist remotely. This can be a convenient option if you're short on time or live far from a healthcare provider.
Understanding BCBS Direct Access
Horizon BCBS Direct Access is designed to make healthcare more accessible and convenient. You start with your Primary Care Physician (PCP), who coordinates all aspects of your medical care and provides referrals to specialists or inpatient facilities.

Your PCP is a duly licensed practitioner who has entered into an agreement with Horizon BCBS to participate in the Managed Care Network. They're responsible for making sure you receive the right care at the right time.
If you don't have a PCP, you can choose any other physician or specialist for your care. However, having a PCP can help ensure you receive the best possible care.
Horizon Direct Access plans also include coverage for acute treatment programs, which deliver short-term, concentrated treatment for severe mental health or substance use disorders. These programs are integrated into BCBS' mental and behavioral health benefits.
You can review your policy documents or call (888) 995-6311 to learn more about your coverage details.
Finding a Direct Access Provider
You can locate a Horizon Direct Access network provider through the Doctor & Hospital Finder or by calling Member Services at 1-800-355-BLUE(2583).
Your Primary Care Physician (PCP) plays a crucial role in coordinating your medical care, including referrals to specialists or inpatient facilities. They're responsible for making sure you receive the right care at the right time.
If you choose not to coordinate care through your PCP, you can still see any other physician or specialist you prefer.
Good Health Begins With Your Doctor
Your Primary Care Physician (PCP) plays a crucial role in your healthcare journey. Your PCP is a duly licensed practitioner who has entered into an agreement with your insurance provider to participate in their Managed Care Network.
They are responsible for coordinating all aspects of your medical care, including referrals to specialists, ancillary providers, or inpatient facilities. You can choose to go to any other physician or specialist if you prefer not to coordinate care through your PCP.
Selecting a PCP can help ensure you receive the right care at the right time, by the right healthcare professional. Your PCP provides medical care or refers you to the appropriate source for medical care.
In the future, technology will allow you to interact directly with healthcare professionals, such as nurse practitioners, via videoconference sessions. This will enable you to get answers to your medical questions quickly and efficiently.
With the help of artificial intelligence and machine learning, the software will become even more intuitive and predictive, making it easier for you to navigate your healthcare.
How to Find a Direct Access Provider
To find a Direct Access Provider, you can use the Doctor & Hospital Finder, a tool designed to help you locate participating providers.
You can also call Member Services at 1-800-355-BLUE(2583) to get the information you need.
New Jersey Medical Detox
Horizon BCBS of NJ may offer coverage for medical detox treatment as part of their substance abuse and addiction treatment coverage.
The Affordable Care Act and The Mental Health Parity and Addiction Equity Act mandate that all health insurance providers provide mental health coverage on par with physical health conditions.
You can call (888) 995-6311 to better understand the medical detoxification treatments covered under your Horizon BCBS of NJ policy.
In New Jersey, medical detox is a covered benefit under certain health insurance plans, including Horizon BCBS of NJ.
BCBS Coverage for Rehab
Horizon BCBS of New Jersey usually covers rehabilitation services related to substance abuse treatment, including detoxification, medication-assisted treatment, inpatient and outpatient care.
You can access a range of services through Horizon BCBS alcohol rehab and Horizon BCBS drug rehab programs.
To confirm the exact terms of your policy, call (888) 995-6311 to speak with a helpful staff member about the rehab admissions process.
Horizon BCBS of NJ typically includes coverage for acute treatment programs, which deliver short-term, concentrated treatment for severe mental health or substance use disorders.
These programs are integrated into BCBS' mental and behavioral health benefits.
The scope of coverage for inpatient rehabilitation can vary due to many factors.
Carefully examine your policy documents or reach out to (888) 995-6311 for clarification on your inpatient rehab coverage.
To check your Horizon BCBS rehab coverage levels, call (888) 995-6311 or fill out a confidential form to access support and guidance every step of the way.
Specialist Referrals and Coverage
If you enroll in a Horizon Direct Access, EPO or EPO Plus plan, you don't need a referral to see a specialist.
You'll have the freedom to choose your own specialist without needing a referral from your Primary Care Physician (PCP).
However, if you enroll in a Horizon HMO Plan, your PCP will provide you with referrals for specialists.
This means you'll need to check with your PCP before seeing a specialist, and they'll guide you through the process.
You can rest assured that you have access to the care you need, whether you're enrolled in a Direct Access, EPO, or HMO plan.
Frequently Asked Questions
Does Horizon Direct Access cover weight loss medication?
No, Horizon Direct Access does not cover weight loss medications. For more information on covered medications, call 1-800-682-9094 (TTY 711).
Is Horizon BCBS the same as BCBS?
Horizon Blue Cross Blue Shield of New Jersey is a member of the Blue Cross Blue Shield Association, but it is a separate entity with its own name and services. While sharing a common affiliation, Horizon BCBS operates independently with its own brand and offerings.
Sources
- https://www.horizonblue.com/members/plans/medical-plans/horizon-direct-access
- https://summithelps.com/insurance/horizon-bcbs/
- https://www.horizonazul.com/en/taxonomy/term/124
- https://milistorage.blogg.se/2023/september/horizon-bcbs-direct-access-providers.html
- https://www.cio.com/article/228334/horizon-blue-cross-blue-shield-of-new-jerseys-dx-dive-into-virtual-medicine.html
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