Anthem Blue Cross and Blue Shield (Anthem) does not require prior authorization for treatment of emergency medical conditions.
As defined by Indiana Administrative Code 405 IAC 5-2-9 and United States Code 42 USC 1395dd(e)(1), an emergency medical condition is a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in the following:
- Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy
- Serious impairment to bodily functions
- Serious dysfunction of any bodily organ or part
In the event of an emergency
In the event of an emergency, members may access emergency services 24/7 at any Indiana Health Coverage Programs-enrolled provider/facility. The provider/facility does not have to be in-network.
In the event that the emergency room visit results in the member’s admission to the hospital, providers must contact Anthem within 48 hours of admission.
Emergency behavioral health services
Primary medical providers should immediately refer any member who is in crisis or who is a threat to self or others for emergency care. An emergency referral for behavioral health services does not require prior authorization or pre-service review.
Page Last Updated: 07/16/2021