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A Letter from Anthem Blue Cross

September 17, 2012

Approval will be needed for sleep therapy starting November 1.

Dear Member:

We want to let you know about new sleep therapy requirements under your health plan. As of November 1, 2012, we are adding sleep testing, therapy equipment and supplies to the services that we must approve before you receive them. This is called pre-approval, pre-authorization, precertification or prior authorization. It's how we review health care services to make sure they meet our criteria for being medically appropriate.

What you have to do
If your doctor is in the plan's network, you don't have to do anything. Your doctor will take care of getting approval for future testing and therapy equipment and supplies before your next treatment and order.

But if your doctor is not in the network, please talk to your doctor about getting our approval for continuing your treatment November 1, 2012, and after.

Our sleep therapy management program
We're introducing a sleep testing and therapy management program. It can help you and your doctor make better informed decisions about your treatment. It will include outpatient and home sleep testing and therapy.
Starting November 1, 2012 and after, the program will require pre-approval for:

  • Home sleep tests (HST)
  • In-lab sleep studies (polysomnography or PSG, a recording of changes during sleep)
  • Titration studies (to determine the right air pressure you need to keep your airways open)
  • Treatment orders for equipment and supplies, including positive airway pressure devices (APAP, CPAP, BPAP), oral devices and related supplies.

Each quarter we'll review if your ongoing treatment still meets our criteria coverage. Your equipment supplier or your doctor may give us ongoing information to help us decide whether to keep covering your sleep equipment and supplies. Our approval will depend partly on how you comply with the treatment.

Get the most out of your benefits with these quick tips

  • Choose doctors in your plan's network. This will keep your out-of-pocket costs lower. Using a doctor who isn't in the network may cost you more. (Or in some cases, may not be covered at all.)
  • Talk with your doctor about your condition and treatment choices. Find out if your doctor will get the pre-approval for you.
  • If you have an emergency, call your doctor and seek immediate medical attention. You don't need pre-approval in an emergency.

If you have questions about your care, please talk with your doctor. For questions about your plan or benefits, please call Member Services at the number on your member ID card.

Sylvia Gates Carlisle, M.D., M.B.A.
Managing Medical Director
Anthem Blue Cross

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association.

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