Your Anthem medical plan recognizes you may have challenges finding an in network provider to perform a specific medical service. Although this is not common, there are times when a specialist may not be available within 30 miles of your home. In addition, an in-network provider may not be available for specific types of services.  For example, even when you receive care at an in-network hospital, staff such as anesthesiologists, radiologists, or pathologists may not be in-network providers. 

 

These examples identify two of the instances where you can receive care from out-of-network providers and arrange for your claim to be paid at the in-network level of coverage.  This arrangement is called an Out-Of-Network Referral.  An Out-Of-Network Referral is an authorization that identifies the services from the out-of-network provider as in-network services and will ensure your claim is processed at the in-network level.  This means your co-payment, deductible and out of pocket maximum will be the same as if you received services from an in-network provider.  Although your pre-authorized services will be covered at the in-network level of coverage, you will be responsible for any provider charges which are above customary and reasonable.

 

Your in-network provider may refer you to another provider for services and, if this occurs, please be sure to verify that he or she is an in-network provider.  If he or she is not an in-network provider, please call customer service for assistance with finding one. If customer service cannot find you an available in-network provider within 30 miles of your home, we can arrange to have you see an out-of-network provider and have your claim paid at the in-network benefit level.

 

If you receive treatment from an in-network hospital and one or more of the providers assigned to provide you care is out-of-network, such as an anesthesiologist or radiologist, your claim for that provider could be paid at the out-of-network benefit level. If this occurs, call customer service to have your claim investigated and, if appropriate, adjusted to the in-network benefit level.  If you find out prior to your service that an assigned provider is out-of-network, you can always call customer service beforehand to obtain an Out-Of-Network Referral.

 

You should contact your dedicated Northrop Grumman customer service unit to assist you with finding a provider, or initiating the preauthorization for an Out of Network referral, at (866) 504-9638 between the hours of 8:00 AM-11:00 PM (EST), Monday through Friday.