Anthem Blue Cross PPO ACO FAQ

Frequently Asked Questions: Anthem Blue Cross PPO Enhanced Care Coordination

How was I chosen to receive these enhanced services?
You were selected because you are an Anthem Blue Cross PPO member who regularly receives care from UCLA Medical Group for ongoing health services.

When will I begin to receive these enhanced services?
The program is active right now. As soon as you sign the Enhanced Care Coordination Participation Member Form and return in the envelope provided, you'll be part of the program at no extra cost.

Will my health plan benefits, costs, deductibles or copays change?
No. Your benefit plan will stay the same. And there will be no change to your health care eligibility with Anthem Blue Cross as a PPO member. The only difference is that you'll have access to a care coordinator/care coordination program to help you better understand the health care system and coordinate your care.

How is my Anthem Blue Cross coverage affected?
There's no difference in your Anthem Blue Cross coverage as a PPO member. You'll still be a part of the Anthem Blue Cross or Anthem Blue Cross Life and Health Insurance Company PPO plan ("Anthem Blue Cross PPO plan"), just as you were before. As a program participant, though, you'll now have access to extra services and highly-coordinated care enhancements of which you may not have been aware.

Do referrals or authorization requirements change with enhanced care coordination?
No. With the enhanced care coordination program, there will be no changes to the way you use your PPO network. If you're referred to a specialist by your doctor, you may choose to go to that specialist or a different specialist - it's your choice. There will be no impact on your benefits as long as you continue to follow the rules of your current Anthem Blue Cross PPO plan.

What about claims?
Claims are not affected at all. Since enhanced care coordination is using your PPO network, there are no changes to the way claims are submitted or processed.

Why don't these services cost more?
We are providing these services based on the idea that most people can stay healthier with a little extra attention from their doctors and care coordinators. We believe enhanced care coordination will help prevent the possibility that illness or complications could lead to an emergency room visit or hospital stay.

Tell me a little about the care coordinators.

  • Each enhanced care coordination member will have a care coordinator available to help with your health care. Our care coordinators can support you by:
  • Answering your questions and giving you information you need to understand their conditions managed by your doctor.
  • Navigating you through coordinated care with your doctors and other health care providers, and scheduling appointments.
  • Supporting you and your family in the areas where you need help.
  • Tracking your care among all of your health care providers.

Can my family members receive these services too?
Enhanced care coordination is only for select Anthem Blue Cross PPO members who would benefit from care coordination. Only members who meet Anthem Blue Cross and UCLA Medical Group criteria are invited to participate. If your family members meet the criteria for participation, they will receive a separate letter, like this one, asking them to join.

Will I still have the same access to my doctor?
Yes. You will still have the same access to your doctor, and as an Anthem PPO member, you will still be able to see any doctor of your choice.

What do I need to do if I decide not to receive these enhanced services?
Nothing. It's your choice. As an Anthem PPO member, you will still be covered as you are now. You may still see your current doctor at UCLA but will not be receiving the extra personalized coordination and services. This program is designed to enhance your health care experience but if you do not enroll, you will still receive excellent care from your physician.

What if I opt into receiving these enhanced services and later decide it's not right for me?
If, at any time, you feel this program doesn't meet your needs or isn't a good fit for you, you may opt out of the program. Your physician's team will help you transition out. You will still have the same access to your doctor, and as an Anthem PPO member, you will still be able to see any doctor of your choice.

What happens if I switch to a different health plan? Will I still receive these enhanced services?
This program is available only to members who are currently enrolled in an Anthem Blue Cross PPO plan. If you switch to another health plan, you will no longer be eligible to participate in this program.