Does Horizon Cover Therapy?
Does Horizon cover therapy?
If you have Horizon Blue Cross Blue Shield insurance and want to know if your plan pays for therapy, the simple answer is yes. Horizon may cover all types of substance addiction and mental health therapy. To qualify for horizon coverage, your provider must document medical necessity for therapy. Several other factors, such as your specific plan, whether your provider is in-network, and the type of therapy you need, may affect your coverage benefits. ChoicePoint works with Horizon BCBS to check your coverage and make it easy to get therapy for addiction and mental health.
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Why Should You Opt for Horizon Covered Therapy?
Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBS) is the oldest health insurance company in the state, established in 1932. As a not-for-profit organization, Horizon BCBS serves individuals, families, employers, and Medicare and Medicaid members across New Jersey.
Horizon Blue Cross Blue Shield pays for mental health therapy and counseling services for members who qualify. This coverage comes under a program called Horizon Behavioral Health.
What Is Horizon Behavioral Health?
Horizon Behavioral Health is Horizon’s special program for mental health and substance use disorder support. It looks after your behavioral health benefits and helps connect you to the care you need.
Horizon Behavioral Health provides:
- Access to in-network therapists, psychiatrists, psychologists, and counselors
- Coverage for in-person, video, and phone-based therapy sessions
- Care management programs for members with complex behavioral health needs
- Substance use disorder treatment, including detox, rehab, and recovery support
- Digital mental health tools and self-check resources
- Educational resources for members and their families
- A 24-hour crisis support line is available every day of the year
Do You Need to Complete Rehab Before Accessing Therapy Through Horizon?
No. Horizon covers outpatient therapy on its own. You do not need to finish a rehab program before your addiction or mental health therapy benefits kick in.
The only requirement is that a licensed clinician must write down your diagnosis and confirm that treatment is medically necessary. Your clinical situation decides the right level of care. There is no rule that says you must finish any rehab program before starting therapy.
What Types of Addiction and Mental Health Therapy Does Horizon Cover?
Horizon covers a wide range of therapies for addiction and mental health. A licensed clinician must do every session, and your diagnosis must show that your treatment is medically necessary.
Cognitive Behavioral Therapy (CBT)
- CBT treats depression, anxiety, PTSD, OCD, and substance use disorders
- Focuses on finding and changing harmful thought patterns and behaviors
- Available in individual and group formats
Dialectical Behavior Therapy (DBT)
- DBT is the main treatment for borderline personality disorder and emotional dysregulation
- Combines mental techniques with mindfulness and distress tolerance skills
- Targets self-harm, emotional instability, and impulsive behaviors
Eye Movement Desensitization and Reprocessing (EMDR)
- EMDR therapy works through traumatic memories linked to addiction and mental illness
- Covered for PTSD, complex trauma, and co-occurring substance use disorders
- Well-known for treating trauma-driven addiction
Individual Therapy
- One-on-one therapy sessions with a licensed BCBS therapist or counselor
- Covers all diagnosed mental health and substance use disorders
- Available in-person and via telehealth at the same coverage rate
Group Therapy
- Group therapy sessions led by a licensed therapist for people with similar diagnoses
- Covers addiction recovery, depression, PTSD, and anxiety disorders
- Usually costs less out of pocket than individual sessions
Family Therapy
- Family therapy sessions are covered when clinically necessary and tied to a diagnosable condition.
- Brings loved ones directly into the treatment and recovery process
- Strongly supported in addiction treatment and adolescent mental health care
Mental Health Therapy
- Mental health therapy services are available for individual therapy, behavioral therapy, and medication management
- Coverage may include treatment for generalized anxiety disorder (GAD), postpartum depression, post-traumatic stress disorder (PTSD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and attention-deficit/hyperactivity disorder (ADHD).
- Makes professional mental health support more accessible through in-person and outpatient care options.
Mental Health and Addiction Conditions Covered by HorizonĀ
Horizon’s behavioral health benefits apply to a wide range of diagnosed conditions. Your clinician must write down your diagnosis and confirm medical necessity for coverage to apply.
- Mental Health Conditions: Depression, anxiety disorders, PTSD, bipolar disorder, OCD, schizophrenia, borderline personality disorder, ADHD, and panic disorder.
- Substance Use and Addiction Conditions: Alcohol, opioids, heroin, fentanyl, cocaine, methamphetamine, benzodiazepines, marijuana, Xanax, Morphine, and prescription medication misuse.
- Dual Diagnosis: When a mental health condition and a substance use disorder happen at the same time, Horizon covers treatment that addresses both under your behavioral health benefits. ChoicePoint specializes in dual diagnosis treatment for Horizon members.
How Much Does Addiction and Mental Health Therapy Cost With Horizon?
The costs of addiction and mental health therapy depend on your specific Horizon plan. Most members pay a deductible and a copay or coinsurance per session. An annual out-of-pocket maximum limits the total amount you spend for the year.
| Cost Component | What It Means | Key Detail |
| Copay | A fixed amount you pay per therapy session | Applies after the deductible is met on most plans |
| Coinsurance | Your share of the session cost as a percentage | The common range is 10% to 40% after the deductible |
| Annual Deductible | The amount you pay before Horizon starts sharing costs | Varies widely by plan tier |
| Out-of-Pocket Maximum | The most you pay in a year before Horizon covers 100% | ACA-regulated plans cap at federal limits |
| Session Limits | Annual cap on covered therapy sessions | Varies by plan; many plans have no hard cap |
Does Horizon Require Prior Authorization for Mental Health and Substance Addiction Therapy?
For regular outpatient mental health and substance addiction therapy, prior authorization is usually not needed. It is most often required for higher levels of care. If you start mental health and substance addiction therapy without the required authorization, it can cause claim denial.
Prior authorization is generally required for:
- Horizon-covered Medical Detox
- Horizon-covered Inpatient Rehab
- Outpatient Rehab
- Horizon-covered Intensive Outpatient Programs (IOP)
- Horizon-covered Partial Hospitalization Programs (PHP)
ChoicePoint confirms your authorization requirements with Horizon before you begin treatment at our New Jersey facility or through our online therapy program.
Factors That Affect Your Horizon-Covered Addiction and Psychiatric Therapy Coverage
Horizon looks at several clinical and administrative factors before approving your addiction and psychiatric therapy. Knowing these can help you avoid unexpected gaps or denials.
| Factor | What It Means |
| Medical Necessity | A licensed therapist must document why therapy is clinically required. Without this, Horizon can deny coverage even if your plan includes behavioral health benefits. |
| Diagnosis and Severity | More serious conditions or co-occurring disorders support a stronger case for continued coverage. |
| Level of Care | Treatment must match your documented clinical needs. A mismatch is a common reason for denial. |
| Treatment Progress | Horizon does regular reviews. Your therapist must show measurable progress to keep sessions approved. |
| Prior Authorization | Missing required authorization before starting treatment is one of the most frequent causes of denied claims. |
| Provider Licensing | Your therapist must hold an active license recognized under your Horizon plan. |
Does Beacon Health Limit My Coverage for Rehab?
Yes, Beacon Health can limit your rehab coverage in certain situations. Your plan may not cover all treatment types or lengths of stay. These factors may affect the level of coverage you receive:
| Factor | How It Affects Your Coverage |
| Medical Necessity | Beacon Health must determine that treatment is medically necessary. Without this approval, claims may be denied even if rehab is recommended by your doctor. |
| State and Location | Coverage rules differ by state. Some states have stronger mental health parity laws that require broader coverage. Your location affects which providers are in-network. |
| Network Status | Going to an in-network rehab facility like Choice Point typically costs less. Out-of-network care may result in higher out-of-pocket costs or a full denial. |
| Type of Treatment | Inpatient rehab, outpatient programs, and detox each have separate coverage rules. Your plan may cover some levels of care more generously than others. |
| Length of Treatment | Beacon Health may require regular reviews to keep approving coverage as treatment continues. Longer stays require ongoing clinical justification. |
| Prior Authorization | Some services require pre-approval before treatment begins. Without prior authorization, even covered services may not be paid for. |
| Deductibles and Copays | Your plan may require you to meet a deductible or pay a copay at each visit. These costs apply even when your treatment is covered. |
| Plan Tier | The specific level of your Beacon Health plan affects how much is covered. It also determines how much you pay out of pocket. |
Do I Need to Pay Anything Even If Beacon Health Is Covering My Rehab?
Yes, in most cases, you will still have some out-of-pocket costs for rehab even when Beacon Health is covering your rehab. The amount depends on your specific plan. Your plan is unlikely to cover 100% of all expenses. You may need to pay some or all of the following:
- Deductible: The amount you must pay each year before your insurance starts covering costs. It can range from a few hundred to several thousand dollars, depending on your plan.
- Copayment (Copay): A fixed dollar amount you pay for each visit or service. For example, you may owe $30 per therapy session.
- Coinsurance: A percentage of the treatment cost you share with your insurer after your deductible is met. For example, you may pay 20% of the total bill.
- Out-of-Pocket Maximum: Once you reach this annual limit, your plan covers 100% of costs. Until then, your share of costs continues to add up.
- Non-Covered Services: Some services may not be included in your plan. These can include certain holistic therapies or private room upgrades.
- Out-of-Network Charges: Using a provider outside Beacon Health’s network can cost significantly more. In some cases, the full cost may fall on you.
- Prescription Costs: Medications used during treatment may have separate copays. MAT medications like Suboxone or Vivitrol are billed through your pharmacy benefit.
Our team at Choice Point will walk you through all expected costs before treatment begins, so there are no surprises.
Check Your Insurance Coverage With ChoicePoint
Whether youāre in Fair Lawn, NJ, or anywhere else in the United States, call 844.445.2565 Our admissions team verifies your exact in minutes and handles prior authorization so you can start treatment stress-free.
How to Verify Your Horizon Benefits for Substance Addiction and Mental Health at ChoicePoint?
Before starting substance addiction and mental health therapy, check your benefits so you know what your plan covers, what you will pay, and whether any services need prior authorization.
Step 1: Contact Us
Visit the website and navigate to Admissions > āverify your insuranceā through ChoicePoint or call us at 844-44-2565.
Step 2: Submit Your Details
Share your Horizon member ID, basic personal details, and the type of therapy you are looking for.
Step 3: We Review Your Coverage
Our team contacts Horizon, checks your coverage, and calls you with a complete breakdown of what to expect throughout your addiction or mental health therapy.
FAQs About Does Horizon Cover Therapy?
People with horizon coverage often ask these questions before getting in therapy,
Does Horizon cover online therapy?
Yes. Most Horizon plans cover telehealth therapy at the same copay as in-person sessions. Federal rules require that cost-sharing for virtual sessions match in-person rates on most plan types. ChoicePoint offers secure telehealth therapy for Horizon members.
Do I need a referral to start therapy with Horizon?
PPO and EPO members can access therapy without a referral. HMO members typically need one from their primary care physician. ChoicePoint confirms your referral requirements during free benefits verification.
How many therapy sessions does Horizon cover per year?
It varies by plan. Under the MHPAEA, any session limit on mental health care must be no stricter than limits on comparable medical care. ChoicePoint checks your session limits during benefits verification, so you know exactly where you stand.
Is my therapy confidential, even though Horizon is paying?
Yes. HIPAA protects all session content. Horizon receives only standard billing and diagnosis codes. Your employer, family members, and other third parties cannot access your session details without your written permission.
Other Major Insurance Plans We Accept
