CommentLast month, I discovered I had a tick on me which I had for four days. It was on my head but under my hair and I did not notice it. I had symptoms the third day and went to MedCare for diagnosis.
The doctor said I would be treated for possible Lyme disease.
As far as I’m concerned, this is not a pre-existing condition.
Horizon sent me a letter saying this claim would have to be reviewed for pre-exisiting conditions and they would send my doctor a questionnaire which would need to be sent back within 45 days or the claim would be denied.
A week later I call Horizon to see if they sent the form out to the doctor - no we didn’t they say. I said how can my doctor be expected to know to send a form back if she didn’t get one?
I checked with my doctor to see if she got the claim and they haven’t.
I called Horizon again and they said they would sent a form out - so we shall see - I suspect they will give me the runaround for 45 days and then deny the claim.
If they do, I will go through their appeals process. We shall see.
I called Horizon on 7/22 they told me they received the information from the Dr on 6/11 and that I would have to wait SIXTY business days for a decision as to whether or not the tick bite I received was a PREEXISTING CONDITION.
This puts the date for the decision at Aug 28, 2008.
I waited and waited and nothing until last week when my doctor calls me and tells me that unless Horizon pay the claim they will be billing me.
Such contrast to what Horizon say “until a determination is made you are not responsible” for the bill.
I sent a letter to Horizon BCBSNJ requesting information by the end of this month. It has been four months since I was seen by this doctor and Horizon BCBSNJ refuse to look at my claim and communicate with me.
The funny thing is they paid my lab fees, yet they won’t pay me doctor’s bill.
I call again on Oct 23, 2008 and the rep said that I have a preexisiting condition clause. I said, "so, basically, Horizon only cover emergencies for the first year" which she more or less confirmed.
DO NOT BUY HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY INSURANCE
THEY ARE A RIP-OFF, A SCAM
THEY WILL DENY PAYMENT, DELAY PAYMENT AND EXPECT YOU TO KEEP PAYING THEIR PREMIUMS WHICH OFFER LITTLE OR NO BENEFITS
HORIZON IS THIEVING SCUM
 Comments (6) |  |
| 1. Written by Evelyn Sagbay, on 12-10-2009 16:02 I have a pretty similar story about how much they suck. I decided to sign on with Horizon last December of 08' I was paying $250 a month, decided to go to the dr. and get my annual pap smear and routine exam. The doctor found a lump in my right breast and wanted for me to follow up with an ultrasound and a breast specialist. To make the long story short the specialist wanted for me to have a biopsy since my insurance did not cover MRI's, after calling they informed me about a pre-existing clause and said that Horizon would have to perform an investigation to see if they would cover the costs,they said they would send my doctor a questionnare to have filled out and it would take 30-45 to review. After seven months of me calling them back and forth and paying for premiums that were not covering anything that I actually needed I decided to cancel the policy. And now I'm receiving bills from the physicians because Horizon denied all the claims. I hate this company, they were a waste of my money, patience, and time! |
| 2. Written by Brian Donohue, on 27-08-2009 11:34 I am a reporter with The Star-Ledger of Newark trying to reach anyone with an experience like this with Horizon. Please email me at or give me a call at 973-392-1543 |
3. Written by Horizon is HORRIBLE, on 19-08-2009 21:36  my father had a massive stroke on feb 19,09. since that date ,he has had a lot of medical complications that have not allowed him to do acute rehabilitation. finally, he is ready for acute rehab, the hospital is ready, and guess what-horizon says that it is not medically necessary! and...they have denied subacute rehabilitation also, saying that it is not medically necessary. I HATE HORIZON!!! THEY DO NOT CARE ABOUT THEIR PATIENTS!!! |
| 4. Written by Max Gorbunovich, on 07-08-2009 13:01 Yes, Horizon BCBSNJ is the worst Insurance you may get. My wife was in a hospital for 30 days. All her treatments were pre-authorized by Horizon and it was an In-Network hospital. Although my insurance policy covers the In-Network hospital treatment 100%, they covered only 19 days and denied remaining 11 days with no explanations. When I asked them to explain me why 11 days were denied, they sent me a letter that they overpaid for the 19 days that were previously covered and requested me to refund the money they paid to the hospital (!!!). Horizon Customer Service is outrageously horrible and useless. |
| 5. Written by MellowCat, on 18-11-2008 21:47 They are under investigation by the governor of your state, I believe. You are right. They are criminals. Par for the course for insurance companies. |
| 6. Written by I. M. Disgruntled, on 24-10-2008 16:32 I feel for you, Horizon will f**k you every chance they get. My Surgeon in Philadelphia said they, Horizon NJ, is the worse insurance to have. |
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