It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF
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Anthem Blue Preferred – Northeast Network<br />
(866) 593-3085 from Oct. 1 to Nov. 5, 2012<br />
(800) 843-6447 after Nov. 5<br />
anthem.com<br />
Overall Quality Rating<br />
See Report Card section<br />
What’s New for <strong>20<strong>13</strong></strong><br />
Beginning in January incentives of $150<br />
are available for members that complete<br />
their biometric screenings and Anthem’s<br />
online health assessment. Contact Anthem<br />
customer service for details on how to earn<br />
this!<br />
Additionally, there are numerous other<br />
incentives available to you through our<br />
SpecialOffers@anthem program. Please<br />
go to anthem.com to check out what is<br />
available.<br />
Provider Directory<br />
To access a copy of the directory, go to<br />
anthem.com/stateofwisconsin. You may<br />
also call Anthem’s customer service area to<br />
request a paper copy.<br />
Referrals and Prior Authorizations<br />
You don’t need a referral when you see a<br />
specialist in the Northeast Network. If the<br />
specialist isn’t in the network, you’ll need<br />
a written referral from your primary care<br />
physician (PCP) and authorization from<br />
Anthem. This plan will pay some or all of the<br />
costs to see a specialist for covered services<br />
only if you have the plan’s permission before<br />
you see the specialist. You will need prior<br />
authorization for some medical procedures.<br />
<strong>Your</strong> PCP or specialist will initiate this.<br />
You also need precertification for nonemergency<br />
hospital stays.<br />
Care Outside Service<br />
Area<br />
For emergency care,<br />
go to the nearest health<br />
care facility. Contact<br />
your PCP and Anthem<br />
within 24 hours or as<br />
soon as possible. For<br />
urgent care, call your<br />
PCP for advice on the<br />
right treatment. All<br />
other services must be<br />
received within your<br />
service area.<br />
Qualified Plan<br />
Non-Qualified Plan<br />
See Glossary for definitions<br />
Mental and Behavioral Health Services<br />
You don’t need a referral to see a Northeast<br />
Network mental health provider. You will<br />
need precertification for inpatient care.<br />
Dental Benefits<br />
No routine dental coverage provided.<br />
Health Risk Assessment Information for Enrolled Members at:<br />
anthem.com/health-insurance/health-and-wellness/hw-overview<br />
<strong>Decision</strong> <strong>Guide</strong> Page 31
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