Filing a Claim for Benefits
Anthem Blue Cross on behalf of Anthem Blue Cross Life & Health Insurance Company is the Claims Administrator for the Network Access Plan (NAP), the Comprehensive Access Plan (CAP), the Retiree Option Plan, and the Medicare Supplemental Plan sponsored by the Pacific Gas and Electric Company. As the Claims Administrator, Anthem Blue Cross contracts with a network of providers and processes claims. Anthem Blue Cross pays the network providers directly for your Covered Health Services. You are responsible for paying copayments, coinsurance and/or deductibles to the network provider at the time of service or when you receive a bill from the provider. If a network provider bills you for a portion of any Covered Health Services that should have been covered by the plan, contact Anthem Blue Cross at 800-964-0530.
When you receive Covered Health Services from a non-network provider, you are responsible for paying the provider up front and filing a claim with Anthem Blue Cross, even if your services were due to an emergency or because your network provider referred you to a non-network provider. You must file the claim in a format that contains all of the information required. Claim forms may be obtained by calling Anthem Blue Cross at 800-964-0530 or by accessing the Anthem Blue Cross website at www.anthem.com/ca/pge.
You must file a claim for payment of benefits within two years of the date of service. If a non-network provider submits a claim on your behalf, you will be responsible for the timeliness of the submission. If your claim relates to an inpatient hospital stay, the date of service is the date on which your inpatient stay ends. If you don't file a claim and provide all required information to Anthem Blue Cross of California within two years of the date of service, benefits for that health service will be denied. This time limit does not apply if you are legally incapacitated.