Our quality standards
Striving to do better, every day
Your health is important to us.
We work hard to make sure you can get great care when you need it. We do this by:
- Having programs and services to help make sure the quality of healthcare you get is even better.
- Supporting pregnant members and new parents with tools and information.
- Finding local programs in your community to help you get the services you need.
- Hosting events to help you learn about your plan and get the most out of it.
- Following state and federal rules.
- Looking at our quality reports to find new ways to offer better care.
Learn more about Quality Management
Have questions about our Quality Management program?
Call us. We can talk to you about:
- What quality management is.
- How we are doing and what our goals are.
- How we are working to make things better for you.
We can also send you information on our Quality Management program.
Hoosier Healthwise, Healthy Indiana Plan
866-408-6131 (TTY 711)
Hoosier Care Connect
844-284-1797 (TTY 711)
Indiana PathWays for Aging
833-412-4405 (TTY 711)
Care management: Helping you manage all the moving pieces
Healthcare can be overwhelming.
Our care managers can help make it easier. Your providers know how to help you with your care. It really helps if you know how to care for yourself, too. That’s what our case managers do.
As an Anthem member, we offer many different types of services. Your care manager works with you and your provider to set up a plan of care. You may already be working with a care manager and know how to contact them.
If you think you need care management services or need help contacting your care manager, call us at:
Hoosier Healthwise, Healthy Indiana Plan
866-408-6131 (TTY 711)
Hoosier Care Connect
844-284-1797 (TTY 711)
Indiana PathWays for Aging
833-412-4405 (TTY 711)
Our care managers may also call if:
- You or your doctor thinks care management might help you.
- You’ve just gotten out of the hospital and need help with follow-up visits to other providers.
- You’re going to the emergency room (ER) often for nonurgent care that could be handled by your provider.
- You call our 24-hour Nurse HelpLine and need more follow-up for ongoing care.
- You have serious physical problems and need more help.
- You have behavioral health problems and need more help working with your providers.
Your care manager can also help with:
- Setting up healthcare services.
- Getting referrals and prior authorizations (approvals).
- Checking your plan of care.
If we call you, a nurse or social worker will:
- Always identify themselves with their name, title, and position with Anthem.
- Tell you about what we offer.
- Talk to you about your health and how you’re handling different parts of your life.
Utilization Management: How we make choices on care and services
Sometimes, we need to make choices about how we pay for care and services. This is called Utilization Management (UM).
Our UM program:
- Looks at what, when and how much of our services are medically needed.
- Always strives for the best possible health outcomes for our members.
Our UM program does not:
- Tell providers to withhold or give you fewer services limiting or denying care.
- Stop certain people from getting services.
- Reward providers for limiting or denying care.
Getting in touch with our Utilization Management staff
Some Anthem services and benefits need prior approval. This means your provider must ask Anthem to approve the services he or she wants you to have. Services that don’t need approval are:
- Emergency care.
- Care needed after a hospital stay.
Our Utilization Review team looks at approval requests. The team decides if:
- The service is medically needed.
- The service is one that is included in your Anthem benefits.
What should you do if Anthem won’t approve care you think you need? You or your provider can ask us to take another look. We’ll let you and your provider know when we get your request. You can ask us to take another look at services that:
- Are not approved.
- Have been limited in the amount or length of time from what was requested.
Do you have questions about an approval or a denial you got? Call Member Services.
Our Utilization Review team or your case manager can help answer your questions.
Hoosier Healthwise, Healthy Indiana Plan
866-408-6131 (TTY 711)
Hoosier Care Connect
844-284-1797 (TTY 711)
Indiana PathWays for Aging
833-412-4405 (TTY 711)
Your opinion matters
Every year, we survey our members about the benefits we offer. If you get a survey in the mail, by email, or phone, please complete it. Help us make your plan better.
New technology in medicine and care
To make sure we are always using the latest medical treatment and equipment to help you feel your best, our medical director and providers look at all the latest medical changes. They look at:
- Medical treatment and services
- Behavioral health treatment and services
- Medicines
- Equipment
They also look at the most up-to-date medical and scientific writings. With all this data, they consider:
- If the changes are safe and helpful.
- If these changes offer the same or better results than what is used today.
This work is done to help us decide if a new treatment or care should be added to your benefits.
You have rights and responsibilities
As an Anthem member, you have rights and responsibilities. They are listed in your member handbook under member materials. Do you need a printed copy of your member handbook? Call Member Services at 866-408-6131 (TTY 711) (Hoosier Healthwise, Healthy Indiana Plan); 844-284-1797 (TTY 711) (Hoosier Care Connect), 833-412-4405 (TTY 711) (PathWays for Aging).
Appeals
You have the right to ask for an appeal if you don’t agree with our decision to deny or reduce a service. An appeal is when you ask us to look again at the care we denied to make sure we made the right decision. Learn more about your appeal rights.
Your benefits and how to get medical care
Are you looking to learn more about our services and benefits? Grab your member handbook under Member Materials.
You can read about:
- Preventive healthcare: Find out how to help prevent many health issues and how to live a healthier life.
- Preventive healthcare for women: Learn how to get access to women’s health specialists for regular and preventive healthcare services.
- Benefits and access to care: Find out more about your benefits and how to get medical care.
- Language help: Learn how to get our information in the language you use at home.
- Pharmacy: Find out about your benefits and how to get the medicines you need.
- Case management: Partner with a case manager to learn more about ways to get care for your health issues.
- Member rights and responsibilities: Read about your rights and responsibilities.
- Notice of Privacy Practices: Learn more about how we keep your private information safe.
- Medical necessity: Find out how we decide if care is right for you based on the right coverage and correct levels of care and service.
- Advance directives: Learn more about your right to use an advance directive (living will), to have one on file or on hand if you can’t tell others about the care you want to keep you alive. Your provider has advance directive forms and more information.
Your benefits include many medically needed services, such as:
- Inpatient behavioral health services.
- Outpatient behavioral health services.
- Partial hospitalization.
- Treatment and rehabilitative services.
See your member handbook to learn more about your benefits.
You don’t need a referral from your primary medical provider (PMP) to see a behavioral health specialist in your plan.
There are some treatments and services your behavioral health specialist must ask Anthem to approve before you can get them. For information about services that need preapproval, please see your member handbook.
If you have questions about referrals and when you need one, contact Member Services at:
Hoosier Healthwise, Healthy Indiana Plan
866-408-6131 (TTY 711)
Hoosier Care Connect
844-284-1797 (TTY 711)
Indiana PathWays for Aging
833-412-4405 (TTY 711)
Monday through Friday, 8 a.m. to 8 p.m. Eastern time.
Our Notice of Privacy Practices
The notice tells you about how we may use and share your health data.
It also tells you how to get this data. The notice follows the Privacy Rule set by the Health Insurance Portability and Accountability Act (HIPAA). Our Notice of Privacy Practices is in your member handbook as well as on the Anthem website.
Call Member Services if you want a copy of the Notice of Privacy Practices mailed to you.
Hoosier Healthwise, Healthy Indiana Plan
866-408-6131 (TTY 711)
Hoosier Care Connect
844-284-1797 (TTY 711)
Indiana PathWays for Aging
833-412-4405 (TTY 711)
Not a kid anymore? It may be time for a new PMP.
As you become an adult, your healthcare needs start to change.
If you’re seeing a pediatrician, you may want to find a primary medical provider (PMP) who treats adults. Adult PMP offices include:
- Family practice.
- General practice.
- Internal Medicine.
Start by asking your current PMP for a recommendation for a new adult PMP. We’re here to help, too. You can change your PMP at any time. It’s easy with our Find a Doctor tool. Or call Member Services at:
Hoosier Healthwise, Healthy Indiana Plan
866-408-6131 (TTY 711)
Hoosier Care Connect
844-284-1797 (TTY 711)
Indiana PathWays for Aging
833-412-4405 (TTY 711)
Monday through Friday, 8 a.m. to 8 p.m. Eastern time.
Page last update: 12/16/2024