Is Your Provider In Network – Keywords

IS YOUR PROVIDER IN NETWORK?

Although you can go to a doctor, hospital or pharmacy that is not in the network (out of network), you will pay less if you choose to go to one that is in the network.

To see if your doctor is in the Anthem network, visit anthem.com or call 1-800-854-1834.
If your doctor is not in the Anthem network, call 1-800-854-1834 and nominate your health care provider for possible inclusion.
Search for doctors and health care facilities that are in the Hess Medical Plan network and compare them, based on location, cost and quality, using the Find Care tool at anthem.com.

If no network provider is available where you need care, call Anthem — before receiving care — to approve using an out-of-network provider for in-network benefits. Without approval, you’ll receive out-of-network benefits.

What Happens If I Go Out of Network?

When you use an out-of-network provider, the plan will pay coinsurance based on Anthem’s maximum allowed amount. You are responsible for any portion of the provider’s charge that exceeds this amount. For example, if you have met your deductible, the plan will pay 65 percent of the maximum allowed amount for out-of-network care.

If your out-of-network provider charges $600 for a procedure and Anthem’s maximum allowed amount for the procedure is $500, you would pay 35 percent of the maximum allowed amount (35% x $500 = $175) plus the $100 that exceeds the maximum allowed amount, for a total of $275.