Anthem BCBS Physical Therapy in Totowa & Nutley, NJ

Physical therapy for Anthem Blue Cross Blue Shield members through the BlueCard program.

Is Anthem Blue Cross Blue Shield Accepted Here?

Yes. Anthem Blue Cross Blue Shield members are treated at both our Totowa and Nutley, New Jersey clinics, and in-network coverage generally applies.

Here is how that works. Anthem does not write plans in New Jersey — the Blue Cross Blue Shield plan in this state is Horizon. Expert Rehabilitation Group participates in the Horizon network, and Blue Cross Blue Shield members from other states are covered through the BlueCard program, which extends your home plan’s benefits to providers in the local Blues network. In practice: you bring your Anthem card, we treat you, and the claim is routed through Horizon back to your Anthem plan.

What Being In Network Actually Means

Being in network means there is a contracted rate in place, so you pay your plan’s in-network cost share rather than a higher out-of-network rate, and we bill your plan directly instead of asking you to pay up front and seek reimbursement.

For Anthem members, that contract is with Horizon as the Blue Cross Blue Shield plan for New Jersey. BlueCard is what extends it to you: because we participate with Horizon, your care here is processed at in-network benefit levels under your own Anthem plan.

How BlueCard Works for Anthem Members

BlueCard is the arrangement that lets Blue Cross Blue Shield members get care outside their home plan’s state. A few things follow from it:

Your home plan’s terms govern. Your copay, coinsurance, deductible, and annual physical therapy visit limit come from your Anthem plan — not from a New Jersey plan.
Authorization rules follow your plan too. Some Anthem plans require prior authorization or a referral for physical therapy. Which rules apply depends on your specific plan, not on where you are treated.
Claims route through Horizon. We submit to Horizon as the local Blues plan, and Horizon forwards the claim to Anthem for processing and payment.
Your card tells us what to check. The three-character prefix in front of your member ID identifies your home plan, and it is what we use to verify your benefits.

The same applies to Blue Cross Blue Shield plans from other states generally, not only Anthem.

Do You Need a Referral?

Under New Jersey’s Direct Access law, Dr. Sheldon Shterengarts and Dr. Roger Avecillas can evaluate and begin treating you without a physician referral. That is state law, and it applies no matter which plan you carry.

Whether your plan requires one is a separate question. Some Anthem plans still require a referral or prior authorization for physical therapy benefits to pay out, and because your home plan’s rules govern under BlueCard, that is something we confirm for you before you start rather than after.

We Verify Your Benefits Before You Start

Before your first visit our bilingual staff contacts your plan directly and confirms your physical therapy benefits — whether a referral or prior authorization is required, how many visits are authorized, and what your copay or deductible responsibility will be. You will know your costs before treatment starts, not after.

This matters more with an out-of-state Blue Cross Blue Shield card, because the answers come from your home plan rather than from a New Jersey plan. Have your member ID card handy and call (973) 221-5236.

You can also see every plan we participate with on our in-network insurance page.

Check Your Anthem Coverage

Call or text (973) 221-5236 with your member ID card, or contact us online. We will confirm your benefits and get you scheduled — often the same day. Totowa and Nutley, New Jersey.