All Pete Novak wanted was quality health insurance for his family.

Last November, Pete decided to change careers, leaving his executive sales position and corporate health insurance behind. His COBRA plan was about to expire. During COVID-19, he couldn’t afford any gap in coverage.

But when he went online to find a family plan, he couldn’t get a clear answer about when his coverage would start. Calling different health insurers didn’t help either.

“I must have talked to 30 people from five or six big companies,” said Pete. “They either couldn’t grasp my situation or offered me ridiculously expensive plans that weren’t right for my family. I was at my wit’s end.”

But then he got in touch with Justin Syp, a retail sales agent with Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ). “I finally found someone who would listen to me,” said Pete.

A 14-year Horizon BCBSNJ veteran, Justin understood Pete’s tricky situation: navigating the complexities of the individual market to find coverage that would protect his family through the end of the year and then selecting a new plan during open enrollment to insure his family beginning January 1. On top of that, Pete wanted a plan that was comparable to the one his former employer offered, at a reasonable price, too.

“I was able to handle everything,” said Justin. “This was relatively simple for me because I’ve had experience dealing with this many times before. But all of the rules and nuances, processes and terms can be overwhelming for someone who doesn’t spend all their time becoming an expert. My job is to make it easy for the people I help every day.”

It was a little bit of luck and fate that connected Pete and Justin. Justin typically works at Horizon Connect in Moorestown, a one-stop service center that helps people get answers to their insurance questions, choose the right policy or understand how to get the most from their Horizon BCBSNJ benefits. But since the pandemic began, Justin has been taking shifts staffing Horizon’s customer service 800 number – where Pete phoned in.

And Pete was glad he did. “Justin knew exactly what I had to do to enroll, why I had to do it – basically, all the steps I needed to take,” said Pete. “He showed real compassion and a lot of empathy with my situation.”

Three things to know about making health care easier to navigate

1. You are not alone. 

When it comes to navigating the health care system, situations like the one Pete experienced are all too common. Picking a health insurance plan can be especially puzzling, with a number of plans offering different levels of benefits with different out-of-pocket obligations and different premiums. Industry terms like “deductible” and “coinsurance” are confusing to many. And it’s difficult to predict what future health care needs people may have when then they’re selecting a plan.

In a recent study in the Netherlands, which offers health plans through an exchange similar to the one in New Jersey, only 5 percent of customers did a better job at choosing the best possible plan than they would have by choosing at random. Even highly trained people working in the insurance industry made a good choice only about 30 percent of the time.

At Horizon BCBSNJ, top member questions span a number of issues, from the costs of coverage to additional types of insurance, like dental and vision, said Justin. These inquiries peak around the time of open enrollment. But figuring out health care is a year-round endeavor.

2. You have tools to help you

Horizon BCBSNJ members have several ways to navigate their health plans:

• The Horizon BCBSNJ website and Horizon Blue app allow members to view their benefits details and claim status, manage referrals and print temporary ID cards.
• A Horizon Personal Health Assistant can help members schedule doctor appointments, locate community resources and get answers to benefits questions – all at no cost.
• The Treatment Cost Estimator provides insights into the costs of specific procedures, so members can understand what to expect both medically and financially.

Pete has been a regular visitor to the Horizon BCBSNJ website to check on his plan’s status. Although he appreciates the always-on, digital tools, he still finds himself picking up the phone and calling Justin, who gave him his direct contact information in case any questions arose.

3. You have someone looking out for you

This level of dedication isn’t something Pete always saw in his corporate job. “I know what great customer service is,” Pete said. “I know the difference between someone who actually cares about what they do versus just showing up to do a ‘job.’” He now plans to be a Horizon BCBSNJ member for a long time.

Going “above and beyond” is how Justin makes sure Horizon BCBSNJ members understand the ins and outs of their insurance plans and how to make the most of them.

“If I can make people happier than they were before speaking with me, I did my job,” Justin said.