28 How Your Plan Works Introduction Your Plan is an indemnity plan. If you choose to receive Covered Services from a Participating Provider, you will only have to pay applicable Deductibles, Coinsurance, and/or Copayments, as described in the “Schedule of Benefits.” If you choose to receive Covered Services from a Non-Participating Provider, you may also have to pay the difference between the Non-Participating Provider’s billed charge and the Maximum Allowed Amount. Please see the “Claims Payment” section for additional details. To find a Participating Provider for this Plan, please see “How to Find a Provider in the Network,” later in this section. Getting Medical Care When you need to see a Doctor, call their office: • Tell them you are an Anthem Member, • Have your Member Identification Card handy. The Doctor’s office may ask you for your group or Member ID number. • Tell them the reason for your visit. When you go to the office, be sure to bring your Member Identification Card with you. The Plan has complete authority to determine the Medical Necessity of Covered Services. If you disagree with the Plan’s determination, you have the right to file an appeal as described in the Grievance and External Review Procedures” section. You should work with your Doctor or other professional Providers, Hospitals and other facility Providers to: • Obtain any Precertification when it is required; and • File claims. Please see the “Getting Approval for Benefits” and “Claims Payment” sections for further details. After Hours Care If you need care after normal business hours, your Doctor may have several options for you. You should call your Doctor’s office for instructions if you need care in the evenings, on weekends, or during the holidays and cannot wait until the office reopens. If you have an Emergency, call 911 or go to the nearest Emergency Room. Surprise Billing Claims Surprise Billing Claims are described in the “Consolidated Appropriations Act of 2021 Notice” at the beginning of this Booklet. Please refer to that section for further details.