Direct HMO now serving southern California counties

We are pleased to announce our new Pathway HMO (on and off exchange) fee-for-service network design, Direct HMO launched on January 1, 2025.

Direct HMO details:

• Member ID cards show the member’s assigned Direct HMO PCP and phone number. In the lower right corner, they display Pathway HMO. Members may access their ID card virtually through the SydneySM Health app.
• Pathway HMO plans serve Los Angeles, Riverside, San Bernardino, Orange, and San Diego counties in California.

Referrals are required for specialty care:

• Except for behavioral health and other specific services outlined in the member’s plan (for example, reproductive or sexual healthcare services and obstetrical/gynecological care consultations as described in the member’s evidence of coverage for complete benefit information).
• Call our HMO Clinical Operations team toll‑free at 866‑757‑8211 for effective care coordination on all referral and authorization requests.
• Make sure to refer only to our extensive network of Direct HMO specialists. Use our online directory, Find Care, to locate providers in the Direct HMO network. Refer to the FAQ for specific navigational instructions to guide your search. Always refer to the most current dated version for the latest information.
• Submit a completed Referral and Prior Authorization Request Form to ensure timely processing of your referral and authorization requests.

For more information:

• Contract questions: Email SpecialNetworkReq@anthem.com with Direct HMO in the subject line.
• Behavioral health utilization management: Call toll‑free at 800‑274‑7767.
• Utilization/medical management: Call toll‑free at 866‑757‑8211.
• General inquiries: Visit our Contact Us page.