Frequently Asked Questions
All inpatient and outpatient procedures or surgeries performed in a Facility require precertification and authorization. In addition, there are other services listed in the Utilization Review section of your Plan document, that will require precertification and authorization. These include but are not limited to: inpatient and outpatient behavioral health and chemical dependency; home health care and hospice care; physical, occupational, and speech therapy; complex imagining (MRI, PET, CAT scan, etc.); and chemotherapy and radiation therapy. A copy of your Plan document can be found on the mylucenthealth.com portal.
Anthem performs precertification (800-274-7767). PLEASE NOTE: We recommended the provider starts the precertification process 5-7 days prior to the schedule service date.
Providers should call Lucent Health to confirm your eligibility and benefits (telephone: 877-382-8587).
What services are covered as “Preventative Care” and covered 100% of the allowable amount by the Plan?
The preventive care benefits covered under the Plan include:
- Services with an A or B rating recommended by the United States Preventive Services Task Force (USPSTF).
- Immunizations for routine use in children, adolescents, and adults that have a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention.
- With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA).
- With respect to women, evidence-informed preventive care and screening provided for in comprehensive guidelines supported by HRSA (not otherwise addressed by the recommendations of USPSTF).
- All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.
- Routine physical exam and associated diagnostic tests and immunization.
- Prostate Specific Antigen tests.
- Mammograms are limited to one based-line mammogram beginning at age 35 and then annually for ages 40 – 74.
- Shingles Vaccination beginning at age 50.
If you have a procedure that required multiple physician and ancillary doctors to be in attendance to provide services, each provider will bill separately for their services. It is not uncommon for one procedure to result in claims from the facility, a surgeon (sometimes multiple surgeons), anesthesiologist (sometimes multiple anesthesiologists), and a laboratory. The Plan will process and pay your claims as they are received, and you will receive an explanation of benefits for each claim submitted for payment.
How do I submit a claim for reimbursement to Lucent Health if I had to pay for the services and the provider will not submit a claim?
Click here to print and complete a Health Claim Reimbursement Form. Submit the completed form with a copy of a Superbill from your provider and a receipt of your payment to email: CA.firstname.lastname@example.org –or– fax: 916-669-0572
Lucent Health Customer Service can answer any question you have regarding these issues. You can also go to MyLucentHealth.com by clicking the link below for answers and resources or download the Lucent Health app from the Apple App Store or Google Play
The Pharmacy Benefits Manager is CostcoRx* They can be reached at 877-908-6024 or via the hyperlink below.
Where can I go for (free to me) help with 24/7/365 assistance with quality health care without leaving my home?
HealthTap members get 24/7 access to U.S. based, board-certified doctors by text or video. Their primary care doctors provide individual treatment plans for each patient, including reminders and checklists to keep you on track. Just use the hyperlink below or download the app from the Apple App Store or Google Play. Be sure to use this code to activate your account: RKjrCn6qGoJU
For Physician and Ancillary Services, your Plan utilizes a Physician and Ancillary Only network called Anthem.
However, your Plan is Open Access for facilities, physicians and ancillary providers which allows you to choose any service provider and facility. Your cost-share (applicable deductible, out-of-pocket, and copays amounts) will not be affected by the provider’s lack of participation in Anthem. Further, you can choose to receive services at any hospital, skilled nursing facility, ambulatory surgery center, or behavioral health facility, where inpatient or outpatient services are provided.