Full HMO network East Bay Counties October 2017 Find a provider near you With our plans you have a great choice of doctors, hospitals and other providers to choose from. 38317CAMENABC 9/16 Welcome Finding the right doctor is important to your health and well-being. With your Anthem Blue Cross (Anthem) health plan, you can choose from high-quality doctors and hospitals in your plan. We have negotiated special rates with them for their services to Anthem members like you. Doctors who aren’t part of this plan can charge what they want, which could cost you much more. That means you’ll save on your health care costs when you choose a doctor in your plan. We’re sharing a list of doctors in your plan to help you fi nd the right one for you and your family — and to help you save money. You can also go to anthem.com/ca or download our convenient Anthem BC Anywhere mobile app to search for doctors by location, type of doctor or other preferences. If you need help or would like to talk to someone about fi nding a doctor near you, just call the Customer Service number on your ID card. Si necesita ayuda en español para entender este documento, puede solicitarla sin costo adicional, llamando al número de Servicio al Cliente que aparece al dorso de su tarjeta de identificación o en el folleto de inscripción. 44907CAMENABC Rev. 06/16 How your plan works HMO: Health maintenance organization. It’s a type of health plan that only covers services from doctors and hospitals in your area. You’ll need to choose a main doctor, also called a primary care doctor, from your HMO doctors. If you need a specialist, you’ll most likely have to go through your primary care doctor to get a referral. Some HMO plans may have different rules. So be sure to check your plan details. If you are a member, you are entitled to language interpreter services at no cost. Members can get language assistance by calling 1-888-254-2721. All members, including members with disabilities, are entitled to full and equal access to covered services. Anthem makes available to its members information relating to their health plan in alternative formats, including electronic, braille, large print and audio (CD or mp3). Members may request an alternative format of a member document by calling the Customer Service number on the back of their member ID card, or by logging in and emailing us using the email feature on the Customer Support page of anthem.com. If you fi nd information in this directory that you think is inaccurate, you can let us know by writing us at [email protected] or by calling 1-844-839-4049. Some hospitals and other providers do not provide one or more of the following services that may be covered under your plan contract and that you or your family member might need: family planning; contraceptive services, including emergency contraception; sterilization, including tubal ligation at the time of labor and delivery; infertility treatments; or abortion. You should obtain more information before you enroll. Call your prospective doctor, medical group, independent practice association, or clinic, or call the health plan at the number on the back of your ID card to ensure that you can obtain the health care services that you need. What you need to know about appointments We’re committed to making sure you have access to the care you need — when you need it. So here’s a brief rundown of how long it should take you to get an appointment with a California Behavioral/Mental Health, Employee Assistance Program (EAP) or Medical provider. Standard waiting times for CA Behavioral Health care: Type of care Waiting time Emergency care (call 911 or go to the nearest Immediately emergency room) Emergency (not life-threatening) 6 hours Urgent care that does not need a prior OK by us (this is called 48 hours prior authorization) Urgent care that needs prior authorization 96 hours }}15 business days for psychiatrists** Routine office visit/non-urgent care appointment }}10 business days for a behavioral health care provider who is not a psychiatrist A live person or recorded message for emergency and non-emergency care is available 24 hours a day, seven days a week. After-hours care (when a behavioral health or EAP provider’s The live person or recorded message should also tell you: office is closed) }}How to reach a behavioral health/EAP provider }}When to expect a call back for urgent matters that aren’t an emergency You will usually not have to wait more than 15 minutes to see In-office waiting room time a doctor, nurse or designated assistant. ** This date is 10 business days for Psychiatrists when the appointment is an initial appointment due to accreditation standards. Standard waiting times for CA Medical Care: Type of care Waiting time Appointments with your primary doctor that aren’t urgent care 10 business days Urgent care appointments that do not need a prior OK (this is 48 hours called prior authorization) Appointments with specialists for care that is not urgent 15 business days Urgent care appointments that do need prior authorization 96 hours Appointments for ancillary services (for diagnosis or treating an injury, illness or other health condition) that is not 15 business days urgent care 66465CAMENABC Rev. 05/17 Type of care Waiting time You will usually not have to wait more than 15 minutes to see In-office waiting room time a doctor, nurse or designated assistant. A live person or recorded message for emergency and non-emergency care instructions is available 24 hours a day, After-hours care (when a doctor’s office is closed) seven days a week. You should also be told when to expect a call back for urgent matters that aren’t an emergency. Emergency care (call 911 or go to the nearest Immediately emergency room) Question for Anthem’s Customer Service by telephone on how 10 minutes to reach a live person by phone during normal to get care or solve a problem, including mental health business hours. The wait time is not to exceed 30 minutes. A nurse line is Question for a nurse on how to access care or solve a problem available 24 hours a day, seven days a week; the number can be found on the back of your member ID card. If you need the services of an interpreter, the services will be coordinated with scheduled appointments and will not result in a delay of an appointment with a participating provider. To learn more about your health care and benefits, please see your Certificate or Evidence of Coverage or call the Customer Service phone number on your ID card. You also can call if you are having difficulty getting an appointment within these waiting times. How we choose doctors and hospitals for our plans We work closely with doctors, hospitals and other health care professionals in your plan so you can get high-quality care while keeping monthly payments as low as possible. Types of health care professionals To best meet your health care needs, our plans include a wide range of facilities and health care professionals, including: }Primary care doctors }Specialists }Behavioral health doctors }Hospitals }Skilled nursing facilities }Labs We look at these areas when deciding which doctors and hospitals to include in our plans: Quality of care We want to make sure you can get high-quality care. Before doctors and other health care professionals join our plans, we check to see that they have the education, licenses and training as appropriate for the care they provide for our members. We don’t have specific quality, member satisfaction or patient safety measures for choosing doctors and hospitals to be part of our Marketplace plans. However, we check and promote quality of care by offering programs* like: }Enhanced Personal Health Care (EPHC): Gives primary care practices the tools and data they need to help care for their patients, including managing health conditions or getting preventive care. This program rewards doctors for meeting quality care measures, improving patient health and lowering the cost of care. }Quality-In-Sights®: Hospital Incentive Program (Q-HIP®): Pays an incentive to hospitals when they follow certain quality guidelines and best practices set by national groups to improve the quality of care. Hospitals are rated on their track record for procedures and a patient’s care. The goal of this award-winning program is to help all patients get the best health care. }Blue Distinction Specialty Care® program: Helps you find facilities with experience in providing high-quality care for bariatric surgery, cardiac care, knee and hip replacement, spine surgery, maternity care and transplants. These facilities also take steps to make care more affordable for patients. }Blue Physician Recognition: Names doctors who offer high-value, high-quality care to patients with certain health problems such as asthma, diabetes and cardiac care. They also take part in local, national and regional quality improvement programs. *Not all programs are available in all states. 53290MUMENAIN 04/16 }Blue Precision program: Recognizes specialists who meet or beat measures for giving quality and affordable care in certain specialties. They must show they follow proven care guidelines or have been recognized by a group such as the National Committee for Quality Assurance. }Physician Quality Measurement (PQM): Gives quality of care results for primary care doctors. This includes showing if their patients received certain preventive care such as cancer screenings. }Anthem Quality-In-Sights®: Primary Care Program (AQI): Evaluates and rewards primary care doctors who meet measures for providing affordable, high-quality care.