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Referrals and Prior Authorization

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 authorization is required prior to your initial visit.

As a PPO member, it’s your responsibility to ensure that you’ve received the proper prior authorizations before getting care.

Prior Authorization

As a PPO member, it’s your responsibility to ensure that you’ve received the proper prior authorizations before getting care.

Some services, such as a non-emergency hospital stay, scheduled procedures and conditions that need treatment require prior authorization. Call Anthem Health Guide toll-free (833) 674-9256, Monday through Friday, 8:00 a.m. to 8:00 p.m. (Pacific) for assistance.