Managing the Cost of Healthcare for Anthem Members

If you’re receiving care at HCA for a serious or complex condition (including pregnancy or ongoing treatment for a serious condition) you may qualify to continue seeing your current doctor for a limited time even if HCA leaves our network. This is referred to as Continuity of Care. For details and a list of qualifying conditions for your health plan type, please call the number on the back of your member ID card.

With this change, Pathway Essentials members will have in-network access to UCHealth, Children’s Hospital Colorado, and CU Medicine for primary, specialty, and pediatric care.

However, if a member does not believe there is an in-network care provider who can provide a covered service needed within a reasonable travel distance, a member or their care provider may contact Anthem and request that Anthem authorize the member to receive the covered service from HCA with in-network member cost-share responsibilities. If Anthem agrees, Anthem will arrange for the member to get the covered service from HCA at in-network benefit levels. Members can also learn more about Anthem member cost-sharing responsibilities and potential balance billing obligations regarding non-participating care providers by calling the member services number on the back of their Anthem ID card or by referring to their plan documents.

If a member receives emergency services or is approved by Anthem to continue care with HCA, that member will not be responsible for more than the in-network cost share (deductible, copay, or coinsurance) for covered services as outlined in their plan.

If a member continues to receive non-emergency services from a HCA provider without prior approval from Anthem on or after December 1, 2026 the member may be responsible for the difference between what is allowed by their health plan and what HCA chooses to bill.

We’re here for you. Call Member Services at the number on your Anthem member ID card. We can help you understand your benefits, possible Continuity of Care options, or find another in-network provider.