Answers to frequently asked questions (FAQs) are organized by topic so you can get the help you need.
How do I contact Anthem Health Guide?
Call Anthem Health Guide, toll-free, at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).
How can Anthem Health Guide help me?
Anthem Health Guide can help you:
- Find an in-network provider.
- Work with your doctor to coordinate care.
- Connect with a ConditionCare nurse to help you manage a chronic condition, such as asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes and heart failure and improve your quality of life.
- Connect you with Anthem 24/7 Nurse Line.
- Review the status or outcome of a medical, behavioral health or pharmacy claim.
- Understand your plan benefits.
Begin your search at anthem.com/ca.
- Log in to anthem.com/ca > Find a Doctor. Or call Anthem Health Guide, toll-free, at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific).
- Enter the type of provider you’re looking for, such as family practice, internal medicine, dermatologist or behavioral health.
- Enter your location and the distance you’re willing to travel.
- (optional): Click Accepting New Patients and/or Able to Serve as Primary Care Physician.
- Click Print to create a PDF directory of the first 250 providers of your search results that you can print and/or email. (This is not a list of all providers.)
What options do I have if my doctor is not in-network?
Anthem has more than 60,000 physicians in its PPO network within California, and 92% of U.S. providers belong to the BlueCard® national network. You can get care from any doctor; however, you will generally have lower out-of-pocket costs when you visit in-network providers.
Can my doctor join the Anthem network?
Any provider can reach out to Anthem Blue Cross’s Provider Relations team to become an Anthem Preferred provider. A provider who joins Anthem Preferred must be willing to see all Anthem Blue Cross PPO members, not just UC members.
Do I receive a member ID card? Do my family members receive their own ID cards, too?
Each enrolled member will receive an ID card. Follow these steps if you need member ID cards right away.
Do I need to select a PCP before seeing a specialist? How do referrals work?
You have the flexibility to see some specialists—such as a dermatologist or cardiologist—without a referral.
However, some specialists and specialty treatment centers (like ones for nephrology or infusion) may require a referral or prior authorization from your PCP before you can make an appointment.
Be prepared: When scheduling an appointment, ask if a referral and/or other authorizing information is required. Find a list of services that require prior authorization in the 2018 HSP Benefit Booklet.
You also have the option of going out-of-network. However, to keep your medical costs down, it’s wise to use in-network specialists and specialty centers.
What do I pay If I go to the Emergency Room (ER)?
After the deductible, you pay 20% of the cost at an in- or out-of-network ER.
What is my cost for an inpatient hospitalization?
After the deductible, you pay 20% of the cost at an in-network hospital. At an out-of-network hospital, you pay 40% of the allowed amount, plus anything over the plan’s maximum payment of $210 per day.
Does my inpatient hospitalization need to be authorized before I’m admitted?
Contact Anthem Health Guide, toll-free, at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific) to verify if prior authorization is required. Also, verify that the hospital and inpatient physicians are contracted with Anthem Blue Cross.
What happens if an out-of-network, inpatient physician sees me while I’m in the hospital?
After your calendar-year deductible has been met, you pay 40% of the cost in excess of the plan maximum of $210 per day.
You are responsible for verifying provider participation for scheduled services. If you researched contracting status of all known providers prior to the scheduled service, but an out-of-network provider was involved in your care, please call Anthem Health Guide, toll-free, at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific). This information will be taken into consideration when reviewing your claim.
Why did I get more than one bill for services received on the same day?
A PPO plan is based on a fee-for-service model. Members receiving certain services will typically receive more than one bill. These services include, but are not limited to:
- Diagnostic services
- Emergency Room care
- Inpatient hospitalization
If a separate physician reviews laboratory testing, you may receive two separate bills—one for the test and one for reviewing the test.
When you have an X-ray, ultrasound, CT scan, MRI, EEG, EKG, stress test, etc., this will result in a bill for the test itself (the technical component) and for the radiologist or cardiologist who reads or interprets the results (the professional service).
ER visits result in at least two bills—one for the hospital or facility charge and one for the ER physician. There is no charge for the ER physician.
Inpatient hospitalizations will result in one hospital bill and other additional bills for inpatient physician services.
How does the deductible work?
Many health plans include a deductible. Except for preventive care, you must satisfy this amount each year before your health plan pays toward most covered services. For more details, visit Medical Benefits or see the Medical Benefits Summary.
How does coinsurance work?
This is the percentage of the allowed amount for covered services you pay under the plan. Your medical plan pays the remaining percentage.
How do I avoid financial surprises when I get care?
Make sure doctors, hospitals and other health care providers are in the Anthem Blue Cross network. If you’re considering a non-network provider, ask how much your charges will be before the visit.
Note: Providers regularly move in and out of the network. While we can’t control that, we can make sure the Find a Provider database is updated as soon as possible.
What is an allowed amount?
An allowed amount is the contracted amount that an in-network provider has agreed to accept as payment in full for covered services. In-network providers render covered services to PPO plan members at contracted rates.
What is balance billing?
Balance billing occurs when you are charged the difference between the Anthem Blue Cross allowed amount and the provider’s billed charges. The amount Anthem Blue Cross pays for a covered service is based on the Anthem Blue Cross allowed amount. Providers within the Anthem Blue Cross network have agreed to accept the allowed amount as payment in full.
Out-of-network or non-preferred providers are not contracted with Anthem Blue Cross and may not accept the Anthem Blue Cross allowed amount as payment in full. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network provider charges $300 for an office visit and the allowed amount is $200, you may have to pay the $100 difference (called balance billing).
How do I find out when my claim is paid?
For each received claim, Anthem Blue Cross will mail you an Explanation of Benefits (EOB) detailing how your claim was paid and the amount you are responsible for paying (e.g. copayment, deductible or coinsurance).
Do I have coverage while traveling or living outside of California (but within the U.S.)?
Yes. The BlueCard® Program gives you access to care across the U.S. You are not required to use a BlueCard provider, but you keep your costs down when you do.
To locate a BlueCard provider:
- Call (800) 810-BLUE (800-810-2583); or
- Search the National Doctor and Hospital Finder.
Do I have coverage while traveling or living outside of the United States?
Yes. When you live or travel abroad, you have access to health care providers for non-emergency and emergency care through Blue Cross Blue Shield Global Core. You are not required to use a Blue Cross Blue Shield Global Core provider, but you keep your costs down when you do.
To locate a Blue Cross Blue Shield Global Core provider:
- Call (800) 810-BLUE (800-810-2583); or
- Search bcbsglobalcore.com.
How do I get prescriptions filled outside the U.S.?
Bring the written prescription from your physician to the pharmacy. Be prepared to make payment at the time of service. Visit anthem.com/ca or call Anthem, toll-free, at (844) 437-0486, 24/7.
You can request up to a 90-day supply of your prescriptions by calling Anthem, toll-free, at (844) 437-0486. For a supply greater than 90 days, please contact your local Health Care Facilitator.
How do I check if my medication is on the Anthem drug list (formulary)?
View the Anthem drug list or call Anthem Health Guide, toll-free, at (844) 437-0486. Pharmacy representatives are available 24/7.
I want to refill my prescriptions via mail service. What do I need to do to get started?
Visit anthem.com/ca or call Anthem Health Guide, toll-free, at (844) 437-0486. Pharmacy representatives are available 24/7.
I am a new enrollee and have received prior authorization for a prescription drug from my previous carrier. Do I need to get authorization from Anthem in order to refill this prescription after my plan’s effective date?
Yes. If you are newly enrolled in a UC PPO plan, your prescribing physician will need to obtain prior authorization from Anthem for your prescription to be covered on your plan’s effective date.
If you have questions about prior authorization or would like to initiate authorization, please call Anthem Health Guide, toll-free, at (844) 437-0486.
I currently take a prescription drug that is listed on my current plan’s specialty prescription drug list. How do I verify if this prescription drug is on the Anthem specialty drug list?
How can I find a specialty drug pharmacy?
Call the Anthem specialty pharmacy—Anthem Health Guide, toll-free, at (844) 437-0486.
What do I pay if I don’t want to use the generic drug prescribed for me?
When a generic drug is available and you choose the brand name drug, you must pay the generic copayment or deductible/coinsurance (whichever is applicable), plus the difference between the cost of the brand name drug and the generic equivalent. Your physician may provide information supporting medical necessity for the brand name drug through the Anthem Prior Authorization process. If the request is approved, you will pay the applicable brand name copayment or deductible/coinsurance (whichever is applicable).
Are my prescription copayments included in my calendar-year deductible and out-of-pocket maximum?
Your prescription costs count toward your medical plan’s annual deductible and out-of-pocket maximum, and vice-versa.