How we make choices on care and services
Sometimes, we need to make choices about how we pay for care and services. This is called Utilization Management (UM).
Our UM program:
Our UM program does not:
Getting in touch with our Utilization Management staff
Some Anthem services and benefits need prior approval. This means your provider must ask Anthem to approve the services they want you to have. Services that don’t need approval are:
Our Utilization Review team looks at approval requests. The team decides if:
What should I do if Anthem hasn’t approved my request?
You or your provider can ask us to take another look at services that:
We’ll let you and your provider know when we get your request.
Have questions about an approval or a denial?
Call Member Services at 800-300-8181 (TTY 711). Our Utilization Review team or your care manager can help answer your questions.
Your opinion matters
Every year, we survey our members about the benefits we offer. If you get a survey in the mail, by email, or by phone, please complete it. Your input helps us make your plan better.