Anthem Blue Cross PPO
UPDATE: Anthem Blue Cross and Dignity Health Agreement
We are pleased to inform you that Anthem Blue Cross (Anthem) today announced it has reached a new agreement with Dignity Health (Dignity) for all commercial products and networks including HMO, PPO, and EPO. This agreement returns Dignity facilities to Anthem health plans while protecting affordability for consumers. This agreement is retroactive to July 15, 2021, which means any care provided to Anthem members over the last month will be considered in-network. There will be no disruption of care.
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The Anthem Blue Cross Preferred Provider Organization (PPO) provides benefits when participants use an in-network or out-of-network provider. However, the levels of coverage are higher for in-network providers than for out-of-network providers.
No referral is necessary from a primary care physician for services of in-network or out-of-network specialists. For many services, members must meet the annual individual deductible before the Plan begins paying benefits.
Services received out of network require you to submit a claim form for processing. You are responsible for paying any difference between the allowed customary and reasonable (C&R) amount and actual charges, in addition to your deductible and coinsurance. Some services may require pre-approval from Anthem Blue Cross. You are responsible for contacting Anthem Blue Cross to determine if potential services are covered or if they must be submitted for utilization review and approval by Anthem Blue Cross.
- Choose practitioners inside or outside PPO network; cost-sharing is higher if out-of-network
- No referral necessary from primary care physician for specialist services
- Higher premiums
- Annual deductible is $250 for individual, $750 for family
- Higher co-pay
- Out-of-pocket (in network) limit is $889 for individual
LiveHealth Online provides 24/7 access to U.S. board-certified physicians with an average of 15 years experience from an Internet-connected device (e.g., computer, tablet, or mobile phone) for non-emergency medical assistance. Anthem members may consult a doctor through LiveHealth Online for free, a savings of $49 per use. Read more and sign up at livehealthonline.com.
Medical Coverage While Traveling
Whether you’re traveling domestically or internationally, Anthem Blue Cross will grant you coverage in the event of a life- or limb-threatening medical emergency. If you are traveling and receive emergency services, remember to retain all your receipts and related documentation. Call your insurance carrier at your earliest opportunity to inform them of any emergency services received.
You have more choices than just the emergency room (ER) that can save you time and out-of-pocket costs. The ER shouldn’t be your first stop — unless there’s a true emergency. While both urgent and emergency care situations are serious, urgent care is for medical symptoms, pain, or conditions that require immediate medical attention but are not severe or life-threatening and do not require use of a hospital or ER. Urgent care conditions include, but are not limited to: earache, sore throat, rash, sprained ankle, flu and fever not higher than 104°. So what do you do when you need care right away, but it is not an emergency?
– Call Anthem’s 24/7 NurseLine at 800-977-0027
– Find an urgent care center by visiting anthem.com/ca.
– Contact doctors through livehealthonline.com.