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.
Your Medicare coverage is primary insurance and your UC coverage is secondary. When you have a Medicare-covered expense, Medicare first pays its share of the cost. Then the UC plan pays a portion, if not all, of the remaining cost, based on the Medicare allowed amount for that service. Medicare determines what is covered and is medically necessary. See medicare.gov for details.
The UC Medicare Supplement plans also pay beyond what Medicare does for certain services, such as inpatient hospital care, physical therapy and more. They also cover certain services not covered by Medicare Parts A & B, such as acupuncture, behavioral health services from providers that don’t accept Medicare (Medicare opt-out providers), hearing aids, and more.
- To find a provider for services that are covered by Medicare Part A or B, go to medicare.gov to find providers near you that accept Medicare.
- To find a provider for services that are beyond Medicare Part A or B or not covered by Medicare (but covered by the plan):
- Go to Anthem and click on Find a Doctor, Hospital or Urgent Care (under Useful Tools).
- Click on the plan name you want to search (e.g., UC Medicare PPO)
- Enter the type of provider you’re looking for, such as acupuncture or behavioral health.
- Enter your location and the distance you’re willing to travel.
You can also call Anthem Health Guide toll-free at (844) 437-0486, Monday through Friday, 5:00 a.m. to 8:00 p.m. (Pacific) for help.
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 for medical and behavioral health services. You will receive a separate ID card for prescription drugs. 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 2020 UC Medicare PPO 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)?
There is no charge for emergency room services.
What is my cost for an inpatient hospitalization?
For hospitals that accept Medicare, facility fees are covered at 100% for the first 60 days. After that, you pay 20% of the cost.
Does my inpatient hospitalization need to be authorized before I’m admitted?
Generally, you don’t need prior authorization from Medicare for Medicare-covered services at a hospital or facility that accepts Medicare. 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.
Why did I get more than one bill for services received on the same day?
Your UC 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).
Inpatient hospitalizations will result in one hospital bill and other additional bills for inpatient physician services.
How does the deductible work?
A deductible applies to non-Medicare covered services and to Medicare covered services not paid by Medicare but paid by the UC plan. The UC plan covers your Medicare Part A and Part B deductible.
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 accept Medicare by going to medicare.gov before your visit. If you’re considering a provider that does not accept Medicare, ask how much your charges will be before the visit.
Note: Providers can change 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?
Medicare determines what is covered by Medicare and pays benefits based on the Medicare allowed amount for that service. The UC plan covers most or all of the cost after Medicare pays its share, based on the Medicare allowed amount.
What is balance billing?
There may be times when you use what Medicare calls a “non-participating provider.” Because these providers are not bound by Medicare, they can charge you more than the amount allowed by Medicare. This means you may be responsible for any costs beyond what Medicare will pay.
How do I find out when my claim is paid?
After you get medical services from a doctor, hospital or other health care provider, Medicare will send you a Medicare Explanation of Benefits. It tells you what the provider billed Medicare, Medicare’s approved amount, the amount Medicare paid, and what you have to pay. Anthem will send you a separate Explanation of Benefits that provides information about how your claim was paid, including how much you owe or will be reimbursed.
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 or call Anthem Medicare Prescription Drug Member Services, toll-free, at (833) 279-0460, available 24/7.
You can request up to a 90-day supply of your prescriptions by calling Anthem Medicare Prescription Drug Member Services, toll-free, at (833) 279-0460, available 24/7. 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 Medicare Prescription Drug Member Services, toll-free, at (833) 279-0460, available 24/7.
I want to refill my prescriptions via mail service. What do I need to do to get started?
Visit Anthem or call Anthem Medicare Prescription Drug Member Services, toll-free, at (833) 279-0460, 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 Medicare Prescription Drug Member Services, toll-free, at (833) 279-0460, available 24/7.
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 Medicare Prescription Drug Member Services at (833) 279-0460, available 24/7.
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?
There is a separate Medicare Part D out-of-pocket maximum that does not count toward meeting the medical plan deductible for non-Medicare covered services or services not paid by Medicare but paid by the plan.