A PPO gives you the flexibility to go to most providers without a referral. However, some specialists—and specialty treatment centers (like nephrology or infusion)—may require a referral from your primary care doctor or prior authorization from Anthem Blue Cross before you can make an appointment.
Be prepared: When scheduling an appointment, ask the provider’s office staff if a referral and/or other authorizing information is required prior to your initial visit.
Certain services, such as a planned surgery with an overnight hospital stay, require prior authorization from Anthem.
For additional information, see the Utilization Review Program section of the 2021 CORE Benefit Booklet.
If you have a procedure scheduled or a condition that will require treatment, you may need prior authorization from Anthem. For assistance, call Anthem Health Guide, toll-free, at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).