Is Horizon Blue Cross Blue Shield Legit? What Do They Do?

Horizon blue cross blue shield

Deciding which healthcare provider you want supporting you and your family can be a daunting task. You might be choosing a healthcare provider for the first time, or maybe you have decided that it's time for a change. No matter the reason, it's difficult figuring out which provider is right for you. Unfortunately, you might not be able to choose the healthcare you want, depending on who you work for and what your company decides is the best option.

Healthcare Providers: Horizon Blue Cross Blue Shield

We will look at what they do and how they do it, reviews of the company, and make an overall assessment of how good the provider is. Our goal is to inform you fully so that you can make a more educated decision on choosing or avoiding Horizon Blue Cross Blue Shield.

Horizon blue cross blue shield

What Is Blue Cross Blue Shield?

First In Healthcare Providers

Blue Cross Blue Shield (BC/BS) is often described as being first in healthcare providers. Keep in mind, being the first does not necessarily mean being the best. BC/BS has the biggest variety of healthcare plans available due to the sheer size of the company, and because of that, it is one of the largest and most well-known healthcare providers in the United States.

One reason for its huge size is that Blue Cross Blue Shield is a federation, made up of around forty different companies. These companies are independent agencies that operate under BC/BS, all within the United States, and offer insurance based on what BC/BS provides. There are also locations outside the United States, in many other countries, but for this article, we will focus specifically on Horizon Blue Cross Blue Shield in the United States.

Horizon Blue Cross Blue Shield

Horizon Blue Cross Blue Shield is one of the many insurance providers that are a part of BC/BS, in Newark, New Jersey. The Horizon division of BC/BS is one of the oldest companies under BC/BS and provides the only licensed plan in New Jersey. So if you are looking at healthcare in New Jersey, Horizon Blue Cross Blue Shield is your primary option for BC/BS. The company provides healthcare insurance for nearly four million people in New Jersey, promising 24/7 medical advice, case management, lifestyle improvement resources, behavioral health programs, and many other services.

What Do They Do?

Healthcare Insurance Plans

taking a blood pressure reading

Being part of BC/BSs net of insurance agencies, Horizon Blue Cross Blue Shield primarily offers healthcare insurance options. There are twenty or more plans that the company has to offer, and when browsing, you can compare up to three at once. There are both standard and subsidy-eligible plans, which include dental insurance, individual health insurance, corporate health insurance, and many others. You can easily go to their website to see if you apply for their health plan.

Other Services

Horizon BC/BS uses OMNIA Health Plans, which allows you to use physicians or other professionals under the Horizon blanket. This sounds nice, but what it really means is that Horizon will only pay for certain doctors or specialists they approve, and nobody else. Horizon offers care programs for chronic issues like Diabetes, they collaborate with companies like Magellan Rx to provide certain injectables, and Horizon also has member-accessible laboratory information for anything you might be concerned about, or interested in.

Well, Are They Legit?

Federation of Businesses

As mentioned before, Horizon Blue Cross Blue Shield is one of many independent insurance companies that make up the huge network that is BC/BS. Because of this, there is no overarching quality control that persists throughout these locations. While they are supposed to work up to the standards of Blue Cross Blue Shield, the companies are free to work to their own beat.

The issue that lies within this is that some BC/BS locations might perform extremely well and provide amazing healthcare insurance, while others might be barely functioning and serve only as a waste of time and money. Unfortunately, by analyzing customer reviews, Horizon Blue Cross Blue Shield appears as though it falls under the second category.

More Negative Than Positive

A majority of the reviews for Horizon Blue Cross Blue Shield on almost every review website are negative. Even the higher rated reviews tend to have an overall negative score or opinion, and you would be hard pressed to find a website that has overall positive scores. Customer service seems to be one of the biggest issues plaguing Horizon Blue Cross Blue Shield, but there are a great number of other problems associated with Horizon.

Some frequent and more notable problems include:

  • Horizon failing to pay claims due to information that the employee mistakenly inputted and never addressing the problem afterward
  • Removing/adding people to insurance policies without being asked to
  • Notifying clients of insurance termination due to late payments that have already been paid
  • Unhelpful call center support, located outside of the United States
  • Having to pay out of pocket for drugs/tools used in procedures
  • Denying insurance for reasonable requests, with unreasonable justification

Denying Insurance And Going Back On Their Word

emergency department of a hospital

That last bullet point is one of the most commonly repeated complaints not only about Horizon but about BC/BS in general. The companies seem to be reluctant to give out insurance based on their own interpretations of the problems. Some people have even reported being denied the opportunity to speak to an actual doctor and instead of having to go through customer service representatives who run the client around in circles.

Many people reported having to fight the company to get insurance for valid medical problems like halter monitors, psychotherapy sessions, and surgeries; surgeries and sessions which had payments approved in the past but suddenly stopped receiving insurance for no clear reason.

There are also many complaints saying that clients were assured coverage for things like vaccines and cancer treatment, but then denied when they tried to receive those vaccines or treatments.

Location, Location, Location

While Horizon Blue Cross Blue Shield offers a ton of different options as a result of being part of BC/BS, they seem to be less concerned with quality. Most of their programs look good on the surface, but the aforementioned problems arise with almost any plan you choose. This particular division of Blue Cross Blue Shield represents just how bad these independent companies can get, and Horizon exemplifies the downsides of a large federation. Not only does Horizon create a bad reputation for itself, but it also puts a stain on BC/BS as a whole.

Blue Cross Blue Shield Texas is another one of these independent companies that operate primarily out of Texas and is very popular. Most of the reviews regarding this branch have to do with the customer service being outsourced or having difficulty navigating the website. The actual healthcare insurance side of the Texas division gets much better reviews than Horizon.

However, for almost every location, there seems to be a recent, increasing number of complaints about BC/BS. Many people are turning away from this provider because of the declining quality of the independent companies under the BC/BS umbrella. It might be the case that your particular location operates at a high level, which is great. But, it appears either BC/BS is implementing new and unfavorable policies, or these companies are starting to all follow each other's bad habits.

Conclusion

When it comes down to it, the most important aspect of choosing BC/BS is to look at local reviews and get to know the independent company in charge of your location. It very well might be the case that, despite most reviews about BC/BS in general, your location might stand out among the others. The large variety of services that BC/BS provides is definitely a great benefactor when you are browsing healthcare insurance. If you can find a regional BC/BS division that applies that selection of services professionally and courteously, then BC/BS is a great option.

But, if your location is among one of the many BC/BS locations like Horizon Blue Cross Blue Shield, then it is best to avoid them altogether. While these divisions claim to be non-profit, they seem to be very stringent when giving out healthcare and do not act like a healthcare provider should, but instead act like they are trying to save money.

The federation aspect of BC/BS could be a factor affecting the way these companies operate, but there are probably lots of other reasons too. Because of this, it is difficult to disparage or blame BC/BS itself for the low-quality of these independent organizations. At the end of the day, it is best to do extensive research into your BC/BS location and find out if they are part of the good bunch or the bad apples. Because the good bunch gets some of the best ratings of any healthcare provider out there; but the bad apples get some of the worst.

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