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Referrals and Prior Authorization

Referrals

PPO Members

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.

HMO Members

The HMO requires that all care—including referrals to specialists—is coordinated by your primary care physician (PCP).

Prior Authorization

PPO Members

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, require prior authorization from Anthem Blue Cross. Anthem PPO members can call toll-free (833) 674-9256, Monday through Friday, 8:00 a.m. to 8:00 p.m. (Pacific) for assistance.

HMO Members

If you’re an Anthem HMO member, you’ll need to work with your primary care physician to get referrals and coordinate authorization from the plan. Some services, such as a non-emergency hospital stay, require prior authorization from Anthem Blue Cross. HMO members can call (833) 674-9257 Monday through Friday, 8:00 a.m. to 8:00 p.m. (Pacific).