Help Patients Avoid Unexpected Costs for Laboratory Tests and Services

When ordering or referring patients for laboratory services, it's important to confirm coverage requirements before services are performed. This is especially important when ordering or referring patients for genetic and biomarker tests, as some of these tests may be considered experimental or investigational.

Some laboratory tests and services may be subject to coverage limitations based on Horizon medical policy and a member's specific benefit plan. If a service is not covered, members may be responsible for the cost, consistent with their benefit plan and applicable law.

Before ordering or referring patients for laboratory tests and services, we encourage providers to:

• Verify coverage requirements to help patients avoid unexpected out-of-pocket costs.
• Review member eligibility and benefits through Availity Essentials℠ and consult Horizon Medical Policies to determine whether a laboratory test or service may be subject to coverage limitations.
• Discuss potential coverage limitations with patients so they can make informed decisions before receiving services.

Taking these steps can help support informed treatment decisions and reduce the risk of unexpected out-of-pocket costs for patients.

Availity Essentials is a product of Availity, LLC. Availity, LLC has contracted with Horizon Blue Cross Blue Shield of New Jersey and its affiliates in the administration of the provider portal. Availity, LLC is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey. Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2026 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105. ECN0027968 (1026)