Glossary

B

Black Lung Clinic — 

providers that receive funding from the HRSA Black Lung Clinic Program to seek out coal miners, whether they are currently involved in mining or not, and provide services to them and their families, regardless of their ability to pay. Services may be provided either directly by grantees or through formal arrangements with appropriate health care providers, such as Federally Qualified Health Centers, hospitals, state health departments, mobile vans and clinics

BlueCard® PPO — 

The BlueCard® PPO program is the premier national Blue Cross and/or Blue Shield Preferred Provider Program that links together more than 600,000 network doctors and 6,000 network hospitals in 48 states. This is a seamless network that affords members the ability to use any network doctor or network hospital in any location. So, for instance, a member that lives in Florida can use network providers in Georgia or any other state, just as if he or she was home. The network also includes hospitals and doctors abroad to make international travel more comforting.
  • No PCP or Referral Needed - With BlueCard PPO, members do not need to select a Primary Care Physician, and referrals are not needed to access specialty care. Members can access any network doctor or hospital at any time and enjoy the in-network level of benefits. Members can also use any doctor or hospital not in the network and receive an out-of-network level of coverage.

  • In- and Out-of-Network Benefits- In- and out-of-network levels of benefits vary depending on each member's group medical benefits. Typically, members enjoy a greater level of coverage when using BlueCard PPO network providers. Members should check with their employer or contact the Horizon BCBSNJ service line for additional information about their benefits.

  • Easy Service — No Hassles - When using BlueCard PPO doctors and hospitals, members have no claim forms to file and virtually no paperwork. All BlueCard PPO providers will handle all of the paperwork for them. Plus, Horizon BCBSNJ offers toll-free customer service Monday through Friday, 8 a.m. to 8 p.m., Eastern Standard Time, so members can get the help they need when it's convenient for them. Members also have access to our interactive Member Web site, where they can look up claim status and enjoy other online services designed to make their health care experience more satisfying.

  • How to Locate a BlueCard PPO Provider - Members can access BlueCard PPO network doctors and hospitals several ways. Using the functionality of this Web site, members can access information about network providers, including directions to their location. Click here to access the BlueCard Physician Finder. Members can also call the BlueCard Access Line at 1-800-810-BLUE (2583) to access PPO providers. If you are not yet an enrolled member, indicate that you are not yet enrolled but are considering becoming a member.

  • Portable Benefits Coverage - So, whether traveling (business or vacation) or living in another state (student away at college), members can take advantage of their benefits by presenting their Horizon BCBSNJ ID cards to any participating doctor or hospital. Once enrolled, members simply carry our easily identifiable ID cards with a PPO in a suitcase logo, which lists a toll-free number to help reach a BlueCard PPO provider.

Board Certification — 

When a doctor or other health care professional is board certified, it means that he or she has met the requirements of the American Board of Medical Specialties (ABMS), American Osteopathic Association or another Horizon BCBSNJ-recognized board, depending on the specialty. To become board certified, a doctor or other health care professional must:
  • Graduate from an accredited professional school
  • Complete specific training in a specialty
  • Practice in that specialty for a specified amount of time
  • Pass a written test

Most boards require doctors or other health care professionals to be periodically recertified. We check specialty board certification before a doctor or other health care professional joins our network(s) and at least every 36 months after that or more often according to state or federal requirements. If you would like more information about your doctor’s or other health care projessional’s board certification, visit the ABMS Web site at abms.org.

Bone Densitometry (DXA) — 

Bone densitometry is low energy x-ray technology that is used to measure bone loss and bone mineral.

Breast Magnetic Resonance Imaging (Breast MRI) — 

Breast magnetic resonance imaging is an MRI that utilizes specially designed coils for the breast to produce detailed images of the breast.Breast MR images allow physicians to evaluate the breast to determine the presence ofdisease that may not have been assessed effectively with other imaging methods.

Breast Ultrasound — 

Breast Ultrasound is an ultrasound of the breast that provides a picture of the breast, tissue and internal composition of the breast. These images help physicians diagnose and treat medical conditions.A breast ultrasound isused to help diagnose breast abnormalities detected during a physical exam and/or seen on mammography or breast magnetic resonance imaging (MRI)

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