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Covered
Horizon Blue Cross Blue Shield of New Jersey typically provides coverage for various allergy immunotherapy treatments, contingent upon medical necessity and specific plan details. This often includes skin prick tests to identify allergens, blood tests for immune response evaluation, and allergy shots (subcutaneous immunotherapy) tailored to desensitize the body against specific triggers. Moreover, sublingual immunotherapy in the form of dissolvable tablets may be covered for certain allergens such as grass pollens, ragweed, and dust mites. The extent of coverage for each treatment or situation may vary and pre-approval may be required; therefore, members should review their individual policy or consult with Horizon BCBSNJ for personalized information regarding their coverage.
Uncovered
Horizon Blue Cross Blue Shield of New Jersey's insurance plans typically exclude certain treatments and situations. Cosmetic surgeries not deemed medically necessary, experimental treatments without substantial medical evidence, and over-the-counter medications are not covered. Services from family members or residents in the insured's home, and work-related injuries covered under Worker’s Compensation, are also excluded. The plans generally do not cover dental treatments unless related to a covered injury or disease, private nursing care, and custodial care like home health aides. Infertility treatments exceeding plan limits, elective procedures, certain weight control services, and routine foot care not associated with a medical condition are also not included in the coverage. Policyholders are advised to check their specific plan documents or contact Horizon BCBS of NJ for detailed coverage information
