Business ProfileforHorizon Blue Cross & Blue Shield of New Jersey

1/12/22 I spoke with ****************, Horizon Medical Director, to appeal ******************* denial for a single case agreement; the appeal was successful, the denial was overturned. **************** authorized a single case agreement for 1/3/2022 7/20/2022 for my patient, Single Case Agreement # ***-282-7029. The agreement outlined the terms: CPT code ***** (26 units), CPT code *********** (26/26 units each), and CPT code ***** (26 units), 100% no responsibility from patient, and deductible waved as well.1/21/22 I spoke with ******************* again, the Behavioral Health clinician who initially denied the single case agreement. We followed up regarding financial negotiations. **** stated someone should be reaching out to discuss a contract.2/18/22 I followed up with provider services regarding not having received a call regarding negotiations. I was transferred to the clinical department authorization line. Reference number for this call: ********** 3/9/22 I called to report I had still not received a call regarding negotiations, I also learned from Horizon ********** that the single case agreement erroneously transferred to the local (************) for payment. Several issues with this: (1) The local started paying as though I was an in-network provider which was a violation of how a single case agreement works. (2) The local stopped paying after 2/1/22 claiming I was not in network (obviously) so they cant pay. I spoke with Horizon Behavioral Health Provider Services in **, they stated they cannot resubmit the claims because it was turned over to the local Highmark. I later learned ******************* was responsible for this error. Reference # for this call: LVP-******* I have 14 more documented calls with Horizon **** through July 2022 with reference numbers that outline details of my case being escalated, I was promised they will correct the error and pay my $175 per session fee, I can provide the details. They stopped responding, payment for 28 sessions is pending. Total owed: $4,900