Anthem Blue Cross
We are Blue Cross – Anthem ♦ Authorized Agents Broker # GFKGQSJSRZ and are happy to help you get covered in CA at no extra charge to you. Blue Cross pays us to help you find their best plan that fits your needs. Here are a few of the many benefits that an agent/broker can provide to the public.
The BEST way to get the most current specific brochures and rates for each plan is to use the button below or logo above and get quotes.
2021 Blue Cross Individual Brochures
- 2021 Covered CA
- Plan Matrix
- Silver HMO EOC Evidence of Coverage-Plain English VERY informative!
- Direct Paper Application - ONLINE is better & faster
- Covered CA - Online Application through Quotit
Blue Cross #MemberPortal
Manage claims, your health, preventative benefits, find doctors, plan details, benefits, refill rx, health assessment and compare costs
FAQ’s Go Paperless
Website Technical Support 1-866-755-2680
Sydney App for iPhone and Android
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Find care and check costs: It’s easy to search for doctors, dentists, hospitals, labs and other providers in your plan. You can search by name, location and type of care. You can even filter by gender or languages spoken, then check costs before you go. This helps you find what’s best for you.
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View claims: With one click, you can check claims. That means you can spend more time focused on your health and less on managing your health benefits.
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View and use digital ID cards: You can always have your most current ID card handy. And you can use it just like a paper one when you visit the doctor, dentist, pay for care and more.
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See all benefits: Sydney shows you essential information at a glance, whether that’s an overview of your plan, health reminders or suggestions for wellness programs. You also can find your deductible, copay and share of costs.
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Use the interactive chat feature and get answers quickly: Simply type your questions in the app and get answers quickly. Plus, Sydney can suggest resources to help you understand your benefits, improve your health and save money.
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Check My Family Health Records (myFHR): myFHR gives you easy access to your health data, including health history and electronic medical records, all in one place. Availability is based on your plan.
Steve Shorr
Website Video #Introduction
Our webpages on our qualifications, reviews, testimonials, etc.
Our Webpage on Insurance Coverage for
COVID 19
#Find a Anthem Blue Cross
Doctor, Hospital and other Providers
Check out this Q & A on finding Providers our webpage
Our webpage on Anthem Blue Cross Provider List Definitions
Use this link to Enroll - So that we get compensated for helping you
Instructions - How to use Provider Search
- What to do when you receive a doctor bill VIDEO
- VIDEO When you're looking for health insurance in California, consider the quality of care provided by Anthem Blue Cross. The Anthem team knows the needs of growing families and offers an array of plans that offer affordable coverage for members of all ages.
- VIDEO What do do when you get a doctor's bill
- Live Health ONLINE - Tele Med with therapist VIDEO
- SYDNEY Overview VIDEO
- What is a provider network Video
- In & Out of Network - What's a network? HN Video
Consumer Resources & Links
Here’s Provider Lists from ALL companies.
Blue Cross SERVICE Phone # (800) 333-0912 or 310.519.1335
Which Blue Cross Anthem Plans are Grandfathered?
What are Multi State Plans?
Broker Information individualbrokers.com/ca1
Specimen Platinum Policy with annotations and bookmarks 2014
WellPoint, Inc. Code of Conduct
Investor Information & Financial Strength
What is a (Blue Cross or Shield) #Multi State Plan under the Affordable Care Act?
The Multi-State Plan (MSP) Program, established under the Affordable Care Act, directs OPM [Federal Office of Personnel Management*] to contract with private health insurers in each State to offer high-quality, affordable health insurance options called Multi-State Plans OPM.Gov FAQ’s
Multi-State Plans are overseen by the U.S. Office of Personnel Management (OPM) and are similar to the other Qualified Health Plan products offered on the exchanges. Generally, all of the same requirements that apply to other products also apply to these Multi-State Plan products. The name “Multi-State Plan” does NOT mean that consumers have health plan coverage for non-urgent care in multiple states. Excerpt from Agent Guide
OPM’s claim to fame appears to be that they have 50 years of experience running the Federal Employees Health Benefits (FEHB) Program. I do not see that the Multi State Programs have anything extra than the others. See also Minimum Essential Benefits and Medical Mandatory Loss Ratio’s
Enroll in Medi-Cal?
Use the #C4yourself website or My Benefits cal.com - Cal Win? based on the County you live in
Plus these programs -
County Medical Services Program (CMSP),
CalFresh (formerly known as Food Stamps) and
California Work Opportunity and Responsibility to Kids (CalWORKs) or check their other website
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NOT C 4 yourself Then find the webpage that you need Apply during business hours Monday – Friday 7:00 am – 5:00 pm at 1-800-281-9799 San Diego County Website
Cal WinPromotional Video How to Video
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Enroll ONLINE my benefits calwin.org
You Tube Channel Videos
Blue Cross – Medi-Cal Commercial VIDEO
We do not represent Anthem for Medi-Cal – Contact them direct
#My Medi-Cal
How to get the Health Care You Need
24 pages
Smart Phones - try turning sideways to view pdf better
- Medi Cal Explained CHCF
- 10 Essential Health Benefits
- Our Webpage on Medi & Denti Cal Benefits
- Western Poverty Law - Exact Legal Rules on Coverage for Low Income Californian's
Nolo Social Security, Medicare, Medi Cal & Government Pensions
Our Webpage on
COVID 19
Provider Lists – Definitions
HMO, EPO
WHAT SHOULD I KNOW ABOUT MY NETWORK?
Exclusive provider organization (EPO):
With our EPO plans, you’ll be able to see any in network doctor. It’s a good idea to have a primary care doctor to coordinate your care, so we’ll pick one close to your home and let you know your assignment in the beginning of the year. You don’t need to see this doctor for services or referrals, and you can change your assigned primary care doctor at any time.
EPO plans don’t offer out of network benefits, except for emergency and urgent care, ambulance services or when a service is pre approved. If you see a doctor not in your plan for any other reason, you’ll have to pay 100% out of pocket.
EPO plans are available in Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mariposa, Mendocino, Merced, Modoc, Monterey, Nevada, Plumas, San Benito, San Joaquin, San Louis Obispo, Santa Barbara, Santa Clara, Santa Cruz, Shasta, Sierra, Siskiyou, Stanislaus, Sutter, Tehama, Trinity, Tulare, Tuolumne, Ventura and Yuba counties.
Health maintenance organization (HMO):
With an HMO, you have to choose a primary care doctor to manage your care needs — including getting referrals to see other network doctors. HMOs don’t offer out of network benefits, except for emergency and urgent care or when a service is pre approved. If you see a doctor not in your plan for any other reason, you’ll have to pay 100% out of pocket HMO plans are available in Fresno, Kings, Los Angeles, Madera, Riverside and San Bernardino counties Brochure * 2021 Brochure *
Formulary
https://fm.formularynavigator.com/FBO/143/2020_Select_4_Tier_CA_IND.pdf
7 comments on “Provider Lists – Definitions HMO, Tiered – PPO, PPO, EPO”
is Blue Cross different than Blue shield?
In California Blue Cross and Blue Shield are two totally different and separate companies.
https://individuals.healthreformquotes.com/employer/companies-carriers/blue-cross-2-2/
https://individuals.healthreformquotes.com/individual/plans/blue-cross/
https://individuals.healthreformquotes.com/companies/blue-shield/
What’s the difference between EPO and PPO?
See above for Blue Cross’s definition of EPO Exclusive Provider Organization. Blue Cross is only offering EPO and HMO Health Maintenance Organizations – that definition is above too.
PPO in San Joaquin County with APTC Subsidies is only offered by Blue Shield – https://individuals.healthreformquotes.com/companies/blue-shield/member-portal/provider-finder/
Basically, a PPO allows one to go out of network, but the reimbursement will be less. See your summary of benefits or EOC
Here’s the EOC Evidence of Coverage for Blue Shield PPO Silver 70
Participating (Participating Provider)
A provider who participates in this plan’s network and contracts with Blue Shield to accept Blue Shield’s payment,
plus any applicable Member Cost Share, as payment in full for Covered Services. Also referred to as an in-network provider.
Blue Shield PPO Brochure
Preferred Provider Organization (PPO)
A type of health benefit plan designed to give enrollees incentives to use health care providers designated as “preferred providers”, but that also give substantial coverage for services received from other health care providers.
PPO plans can also be distinguished from HMO plans by the ability of PPO members to see any specialty physician without referral from a PCP, although some HMOs with a POS feature may allow this as well. See also HMO See our HMO, EPO & PPO page https://individuals.healthreformquotes.com/definitions-glossary/
PPO definition analysis by ensure me Kevin.com
High deductibles ruin it
https://insuremekevin.com/california-ppo-plans-come-with-high-deductibles-max-out-of-pocket-amounts/
Can I get a in network providers list in the mail?
Call Member Services on the back of your ID Card. Source If you would like a pdf, just let us know your California Zip Code, plan and type of MD you want. Or use the link at the very beginning of this page. Please send us a copy of your ID card to verify network.
I’m tired of this back and forth trying to figure out the “websites”.
If financially better I want to change to Anthem blue cross PPO at the same level of coverage I currently have. [Gold]
If this requires a phone call that’s fine.
Watch this video we just made to help answer the question.
https://youtu.be/aZQzZuGi9VM
I don’t like my EOB Explanation of Benefits online, pdf, electronic, etc. Can I get paper copies mailed to me?
Here’s Blue Cross’s FAQ’s
Q: Do I have to go paperless?
A. Not at all. The choice to go paperless or stick with paper claim summaries is up to the subscriber. But going paperless is a great option.
Here’s Blue Shield’s explanation
Here’s a 2 page pdf on how to read Blue Cross’s EOB
More information on Claims Payment Policies & Practices
Here’s a Blue Cross subsidiary’s answer!
How do I get a paper EOB?
Answer: You may contact Member Services at the telephone number listed on your ID card to obtain a paper copy of an EOB. Carefirst
If you appoint us as your broker, no extra charge, we can do this for you.
I have anthem blue cross, but I’m looking for help inside the plan.
It looks like not what you do, but do you have any suggestions?
What do you mean, help inside the plan?
Steve,
Thanks for taking such good care of us.
You are really a great person in a sea of confusion .
Your loyal client,
Mike
1 I was interested in an anthem blue cross d [direct – not through Covered CA] platinum plan….
2 I have a cancer and
3 I did not have insurance previous. ….
4 is there a waiting period for my treatments
1. Great. Click here for FREE quotes for ALL companies or here to get quotes and enroll on our authorized agent site with Blue Cross.
2. I’m sorry to hear that. Hope you recover soon. Under Health Care Reform, there are no medical history questions. Section 2701.
3. That doesn’t matter either. You can also view a specimen platinum plan here, exclusions start on page 105.
4. No. If you enroll by the 29th at 4 PM you can have coverage starting March 1, 2016. – While the official deadline is the 31st, we are not planning to work the weekend. Mental Health is also an essential benefit.