Contact Anthem Blue Cross of Southern California at: (800) 543-3037 or PO Box 60007, Los Angeles, CA 90060.

No. You can use any Anthem Blue Cross PPO doctor at any time. If you already have a personal physician, we suggest you determine if your physician is an Anthem Blue Cross PPO member by checking the directory or calling their office. You can also locate Anthem Blue Cross PPO doctors online. Refer to the "Online Internet Website-Anthem Blue Cross". Recognizing that there are sometimes changes in between directory printings, it is your responsibility and in your best financial interest, to verify current Anthem Blue Cross PPO Participating Provider status before your obtain services. This is simple to do. Just call the physician's office, hospital admissions office, Administrative Office, or the 800 number listed on your Identification Card.

Anthem Blue Cross PPO providers have agreed to give members health care at a special low cost. Because of these savings, the Health Plan can provide increased benefits when you choose to get your health care from an Anthem Blue Cross PPO doctor, hospital, or other provider.

When you use an Anthem Blue Cross PPO participating provider, you are responsible for only ten percent (10%) of covered charges (subject to Plan deductibles and benefit maximums) of the special PPO contract rate. When you use a non-participating provider, you will be responsible for twenty percent (20%) of covered charges (subject to Plan deductibles and benefit maximums) of the charges as determined reasonable by the Plan. In addition, all hospitalizations in other than Anthem Blue Cross PPO hospitals will be subject to a separate $200 hospital deductible per confinement.

Assume after satisfying the $200 calendar year deductible, that you have a combined doctor and hospital bill for covered charges in the amount of $10,000. By way of illustration, your out-of-pocket expense may be as follows: If you use Anthem Blue Cross PPO doctors and hospital: $10,000 of covered charges reduced to special, contract rate of $7,000. Your out-of-pocket cost would be ten percent of $7,000 or $700. If you use non-contracting doctors and hospital: $10,000 of covered charges is reduced to $9,000, which is the amount determined by the Health Trust to be reasonable and customary charges. From the $9,000 there is deducted a $200 hospital deductible, applicable to hospitals which are not part of the Anthem Blue Cross PPO network. You will be reimbursed by the Plan, eighty percent of $8,800, or $7,040. Your out-of-pocket expense will be $2,960, which is the difference between total charges of $10,000 and Plan benefits of $7,040.

No. Anthem Blue Cross PPO providers will submit your bills directly to Anthem Blue Cross of California. However, if you do not use an Anthem Blue Cross PPO provider, you are required to submit your claims to Blue Cross at: Anthem Blue Cross of California Claims Department P.O. Box 60007 Los Angeles, CA 90060-0007

Generally, you will not make a payment until you receive a statement of the claim, called an Explanation of Benefits or EOB for short, from the Anthem Blue Cross. However, in some instances, an Anthem Blue Cross PPO provider can collect a payment for services up to the amount necessary to satisfy the deductible. To receive benefits, you must meet the eligibility rules of the Health Plan and be eligible for benefits.

Yes. To receive full benefits, the Plan requires all non-emergency hospitalizations to be approved in advance. When you use an Anthem Blue Cross PPO Doctor and Hospital, the pre-certification will take place with no action required on your part. If you choose to go to a non-participating doctor or hospital, be certain that your hospital stay is approved before admission. The number for utilization review is shown on your Anthem Blue Cross PPO Identification Card.

Yes, for inpatient hospital confinement. Benefits are provided only for medically necessary and appropriate services. For example, many elective surgeries are considered cosmetic, for which no Plan benefits are payable. If you have questions as to whether a particular elective surgery is covered by the Plan, you or your doctor should contact Anthem Blue Cross.

Yes, subject to Plan benefits (deductibles and coinsurance), a second doctor's opinion for elective surgery is a covered benefit.

Cost containment provides you with valuable information, so that unexpected out-of-pocket costs can be avoided. When the hospital cost containment program is properly used, you will know in advance whether the proposed services are medically necessary and appropriate, and therefore eligible for Plan benefits.

Yes. Plan benefits otherwise payable may be reduced up to $500. In addition, Anthem Blue Cross utilization review will perform a retrospective review of your hospital stay. No Plan benefits will be provided for days in the hospital, which are not determined to be medically necessary.

Yes. A listing of Anthem Blue Cross PPO chiropractors are contained in the Anthem Blue Cross PPO Directory.

By reading the first couple of pages of the directory, you will be familiar with how to access the Anthem Blue Cross PPO network. There is a separate listing of Anthem Blue Cross PPO hospitals. There is a listing of Anthem Blue Cross PPO physicians, which is broken down by specialty. For example, internists, family practice, and pediatrician doctors. After each physician's name, there is a listing of the hospitals where the physician is affiliated.