Referrals and Prior Authorization

Referrals

PPO Members

The PPO gives you the flexibility to go to most providers without a referral. However, some specialists — and specialty treatment centers (like nephrology or infusion) — may require a referral from your primary care doctor or prior authorization from Anthem Blue Cross before you can make an appointment.

Be prepared: When scheduling an appointment, ask the provider’s office staff if a referral and/or other authorization is required prior to your initial visit.

As an Anthem PPO member, it’s your responsibility to ensure that you’ve received the proper authorizations before getting care.

HMO Members

The Anthem HMO (available only at UC San Francisco, UC San Diego and UC Riverside) requires that all care — including referrals to specialists — is coordinated by your primary care physician (PCP).

Prior Authorizations

PPO Members

As an Anthem PPO member, it’s your responsibility to ensure that you’ve received the proper prior authorizations before getting care. Some services, such as a non-emergency hospital stay, require prior authorization from Anthem Blue Cross. Anthem PPO members can call toll-free (833) 674-9256, Monday through Friday, 8 a.m. to 8 p.m. for assistance.

HMO Members

As an Anthem HMO member (available only at UC San Francisco, UC San Diego and UC Riverside), you’ll need to work with your primary care physician to get referrals and coordinate authorization from the plan. Some services, such as a non-emergency hospital stay, require prior authorization from Anthem Blue Cross. HMO members can call (833) 674-9257, Monday through Friday, 8 a.m. to 8 p.m.