The reimbursement for nonparticipating mental health facility services (for example, intensive outpatient program, partial hospitalization program, residential treatment center, etc.) provided to Anthem Blue Cross (Anthem) consumers of California Public Employees' Retirement System (CalPERS) has changed. On January 1, 2023, Anthem began applying the reimbursement level based on CalPERS consumer benefits.

 

The reimbursement amount is based on Anthem’s nonparticipating rate schedule, which is consistent with how other services are paid. Anthem established the rate schedule, and it is reflective of our statewide PPO rates.

 

Claims payment is based on consumer benefits and coverage. The inpatient provisions below are found in the consumer’s evidence of coverage booklet effective January 1, 2023. A preferred provider means in network with Anthem. Non-preferred provider means nonparticipating or out of network with Anthem.

2023 PERS Platinum Plan
Mental Health Benefits
Inpatient Care
90% Preferred Provider
60% Non-Preferred Provider
2023 PERS Gold Plan
Mental Health Benefits
Inpatient Care
80% Preferred Provider
60% Non-Preferred Provider

 

Access the complete evidence of coverage online at https://www.anthem.com/ca/calpers

 

Consumers should understand:

  • Reimbursement may be substantially less than the amount billed when services are rendered at a nonparticipating provider.
  • They are responsible for their deductible, coinsurance, and any difference between the allowable amount and the amount billed by the nonparticipating provider.
  • They are responsible for submitting a claim if they receive care from a nonparticipating provider.

 

If you are currently a nonparticipating provider and are interested in becoming an Anthem network provider, the instructions on how to apply for network participation are below.

 

Email the appropriate Contract Manager in your area. Include in your email subject line the phrase: CalPERS Recruitment for Network Participation:

  • BHFacilityNoCal@anthem.com for counties: Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Fresno, Glen, Humboldt, Inyo, Kings, Lake, Lassen, Madera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benito, San Francisco, San Joaquin, San Mateo, Santa Cruz, Santa Clara, Shasta, Sierra, Siskiyou, Solano, Sonoma, Stanislaus, Sutter, Tehama, Trinity, Tulare, Tuolumne, Yolo, Yuba
  • BHFacilitySoCal@anthem.com for counties: Imperial, Kern, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura
  • CABHFacility@anthem.com for counties: Los Angeles

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Featured In:
March 2023 Anthem Blue Cross Provider News - California