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Referrals and Prior Authorizations

Referrals

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.

Prior Authorization

Certain services, such as a planned surgery with an overnight hospital stay, require prior authorization from Anthem. If you’re enrolled in Medicare, you may also need prior authorization from Medicare to ensure that your treatment or procedure will be covered by Medicare. For information, contact Medicare directly at 1-800-MEDICARE (633-4273).

For additional information, see the Utilization Review Program section of the 2020 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).