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ANTHEM
BLUE CROSS UTILIZATION REVIEW PROGRAM
This
an important benefit for you if you are enrolled
in Anthem Blue
Cross I or II and do
not have Medicare Part A. This
program provides pre-admission review to determine medical necessity and
length of hospital stay on ALL
hospital admissions. This program will let you know ahead
of time if a procedure is covered under your Anthem Blue Cross
plan. Without the
pre-admission review, your hospital coverage may be reduced as indicated
below.
How
this program works:
- You will receive an identification card with the Utilization Review
toll-free phone number on it
- Proposed admissions are reviewed and deemed necessary or not
- If a proposed
admission is determined medically
necessary,
an initial hospitalization time period is approved
- If a proposed
admission is determined not
medically necessary,
but
you and your doctor elect hospital confinement, then the hospital charges
will be excluded from your regular plan benefits
- If a proposed
non-emergency admission is not
submitted for review, or
an emergency admission is not
submitted
for
review on the first
business day following the admission, the
first $200 of covered expenses are excluded from the regular plan benefits.
Need
more information? Call
LACERA for enrollment information and benefit changes. Call the
insurance
carrier
for plan booklets, claim forms, eligibility and billing questions.
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