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Open Access

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As part of our commitment to making our health plans easier to use, we’ve introduced “open access” for our HMO and Point-of-Service (POS) members. Open access gives members direct access to in-network physician specialists without a referral from their primary care physician (PCP). 
Although members must still select a PCP, they may visit any physician specialist in our extensive HMO Colorado provider network simply by scheduling an appointment directly with that specialist. Point-of-Service (POS) members are not required to obtain a referral when visiting an out-of-network physician specialist but will pay a greater share of the cost for this type of visit. 
Although in-network physician specialist visits do not require a referral for HMO or POS members, preauthorization requirements remain the same. Preauthorization is required for:  
Overnight stays at a facility, such as a hospital or rehabilitation facility, or continued stays past the number of days authorized.
Emergency admissions. HMO members must notify their health plan within one business day, if reasonably possible, after being admitted to a hospital.
Surgical procedures, radiology services, and occupational, physical and speech therapies.
Behavioral health (mental health) care and alcohol/chemical dependency rehabilitation services. You or your provider must call Anthem Behavioral Health toll free at 800-424-4012 to obtain preauthorization or otherwise coordinate these services.
 
Child Health Plan Plus (CHP+) members still must obtain a referral from their PCP for any physician specialist visit.  
We encourage members to continue consulting their PCP to coordinate their health care and for referral recommendations. PCPs help ensure quality and consistency in our members’ overall health care. 
 

This plan overview is intended to be a brief outline of coverage. All terms and conditions of coverage, including benefits and exclusions, are contained in the certificate and Health Plan Description Form, which shall control in the event of a conflict with this overview.

For More Information:
Referrals and Preauthorization FAQ for Members
Referrals and Precertification
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use