Effective January 1, 2021, the Los Angeles County Office of Education (LACOE) will offer a Medicare Preferred (PPO) plan from Anthem Blue Cross (Anthem). Anthem will provide medical benefits for LACOE retirees through Anthem’s Local Preferred Provider Organization (LPPO) product, which includes the National Access Plus benefit. This plan allows members to receive services from any provider, as long as the provider is eligible to receive payments from Medicare.

LACOE member copayments or coinsurance percentages will be the same whether his/her provider is in- or out-of-network. Locally or nationwide, doctors or hospitals — the member’s cost share doesn’t change.

 

Noncontracted providers may continue treating LACOE members and will be reimbursed 100% of Medicare’s allowed amount for covered services, less any member cost share.

 

The Medicare Advantage plan offers the same hospital and medical benefits that Medicare covers and also covers additional benefits that Medicare does not, such as hearing, LiveHealth Online* and SilverSneakers.*

The prefix on the Medicare Advantage ID cards is MBL.

Detailed prior authorization requirements are also available to contracted providers by accessing the Provider Self-Service Tool on the Availity* Portal at https://www.availity.com.

 

Providers will follow their normal claim filing procedures for LACOE member claims.

Providers may call Provider Services at 1-833-848-8730 for eligibility, prior authorization requirements and any questions about the LACOE member benefits or coverage.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross. LiveHealth Online is the trade name of Health Management Corporation, an independent company, providing telehealth services on behalf of Anthem Blue Cross. Tivity Health, Inc. is an independent company providing the SilverSneakers fitness program on behalf of Anthem Blue Cross.


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January 2021 Anthem Blue Cross Provider News - California