Hospital Care — Inpatient
Inpatient hospital care is covered at 100% after a $100 copayment and after meeting the annual deductible, when you use a participating PPO network provider. Non-network inpatient hospital care is covered at 70% of Eligible Expenses after meeting the deductible. For non-emergency inpatient hospital care, pre-authorization is required. A penalty of $300 applies if no pre-authorization is obtained. When services are performed by a network provider, your provider will contact Anthem Blue Cross Medical Management for pre-authorization. When services are performed by a non-network provider, it is your responsibility to contact Anthem Blue Cross Medical Management for pre-authorization or make sure your provider has obtained the necessary pre-authorization. The hospital copayment does not apply to the annual deductible.
Covered inpatient hospital services include:
  • Room and board in semi-private accommodations; private room if a Medically Necessary Covered Health Service (as determined by standards set by Anthem Blue Cross — see "Covered Health Services" under "How Benefits Are Determined").
  • Medical and surgical supplies.
  • General nursing care.
  • Use of operating and special treatment rooms.
  • Anesthesia and its administration by a salaried hospital employee.
  • Administration of blood and blood plasma, including the cost of unreplaced blood, blood products and blood processing.
  • Hospital ancillary services, including laboratory, cardiology, pathology, radiology and any professional components for such services.
  • Routine nursery care for a newborn if the child is enrolled in the NAP.
  • Drugs, medicines and oxygen supplied by and used in the hospital.
  • Pre-admission testing performed within seven days before hospital admission or outpatient surgery.
  • Radiation therapy, chemotherapy, physical therapy, respiratory therapy, and hemodialysis treatment.
  • Short-term speech therapy for correction of speech impairments resulting from illness, injury, surgery, or previous therapeutic processes.
  • Physical therapy when furnished by the hospital as a regular service.
  • Occupational therapy when furnished by the hospital in conjunction with physical therapy treatments.
  • Dental care when a hospital admission is required for dental surgery or extraction of teeth, general anesthesia is required, and a physician certifies that the hospitalization is Medically Necessary.
Under federal law, the duration of benefits provided for any hospital stay in connection with childbirth for a mother or newborn child may not be restricted to less than 48 hours following a normal delivery, or less than 96 hours following a cesarean section. However, this federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her baby earlier than 48 hours (or 96 hours, as applicable).