Anthem Blue Cross Blue Shield

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Prepared by: Anthem Blue Cross Blue Shield Page 1 of 5 Connect for Health Colorado

Anthem Blue Cross Blue Shield

Pathway X with Dental

Product Type: HMO

Accessing Care Outside the service area / State: Out of state only urgent and emergent are allowed. IND Pathway X includes Away from Home Care.

Key Provider Network Features: HMO Colorado’s Pathway X is a Highly Aligned Network which is a statewide network, but is aligned with specific hospitals and physicians in the Front Range. The Front Range Counties (Boulder, Denver Metro area, El Paso/Teller, Larimer, Weld, and Pueblo) are aligned with the following with specific hospital systems: Boulder Community Hospital, HCA (Medical Center of Aurora, North Suburban, PSL Denver, Rose Medical Center, Sky Ridge Medical Center, Swedish Medical Center, Spalding Rehab Hospital, and Rocky Mountain Hospital for Children, Craig Hospital, University Hospital, Memorial Hospital System, Pikes Peak Regional Medical Center, Poudre Valley, Medical Center of the Rockies, and Parkveiw Medical Center. All other counties include all hospitals and providers within our statewide HMO Network. This Highly Aligned Network includes behavioral health, autism, and ancillary providers: PT/OT/ST, home infusion, home health, DME, lab through-out the state; unless affiliated with a non-participating facility. The Highly Aligned Network is open access; which means you will still need to choose a PCP, but you do not need a referral from your PCP see any of the Highly Aligned Network providers.

While we make efforts to ensure that our lists of doctors are up to date and accurate, doctors do join or leave our networks from time to time, and these listings do change. There are hospitals, health care facilities, physicians or other health care providers who are not included in every plan network. There may be higher fees associated with visiting a doctor who is not in our network or for obtaining a service that is not covered by your plan. You may be responsible for those costs. To avoid higher fees We recommend that you confirm your doctor is in network and that the desired service is covered when scheduling your appointment. Please refer to for a current list of network providers.


Hospital Medical Facilities:

Animas Surgical Hospital; Arkansas Regional Medical Center; Aspen Valley Hospital ;Banner - East Morgan County Hospital; Banner - Sterling Regional Medical Center; Boulder Community Hospital; Centura - Mercy Medical Center; Centura - St. Anthony Summit Med. Ctr.; Centura - St. Thomas More Hospital; Colorado Plains Medical Center; Community Hospital; Delta County Memorial Hospital; Estes Park Medical Center; Family Health West; Grand River Hospital District; Gunnison Valley Hospital; Haxtun Hospital District; HCA/HealthONE - Medical Center of Aurora;

HCA/HealthONE - North Suburban Medical Center; HCA/HealthONE - PSL Denver; HCA/HealthONE - Rose Medical Center; HCA/HealthONE - Sky Ridge Medical Center; HCA/HealthONE - Swedish; Heart of the Rockies Medial Center; Keefe Memorial Hospital; Kit Carson County Memorial Hospital; Kremmling Memorial Hospital; Lincoln Community Hospital; Longmont United Hospital; Medical Center of the Rockies; Melissa Memorial; Memorial Health System; Montrose Memorial Hospital; Mount San Rafael Hospital; Pagosa Mountain Hospital; Parkview Episcopal Hospital; Pikes Peak Regional Medical Center; Pioneer Hospital; Poudre Valley Hospital; Prowers Medical Center; Rangely District Hospital; Rio Grande Hospital; San Luis Valley Health Conejos County Hospital; San Luis Valley Regional Medical Center; Sedgwick County Hospital; Southeast Colorado Hospital District; Southwest Memorial Hospital; Spanish Peak Regional Medical Center; St. Mary's Hospital and Medical Center; St. Vincent Hospital; The Memorial Hospital; University Hospital; Vail Valley Medical Center; Valley View Hospital; Weisbrod Memorial Hospital (dba Kiowa Hospital District); Wray Community Hospital; Yampa Valley Hospital

Emergency Care & Urgent Care Facilities: Emergency Care can be obtain at the Hospitals and the following Urgent Care Facilties: Advanced Urgent Care; After Ours Urgent Care; Alliance Urgent Care; Animas Urgent Care; Arapahoe Peak Health Center; Associates in Family Medicine; Avon Urgent Care; Boulder Community Medical Center; Boulder Medical Center; Briargate Medical Campus Urgent Care; Castle Pines Urgent Care; Colorado Springs Health Partners Urgent Care Clinic; Colorado urgent Care Physicians, PC dba Doctors Express Englewood; Colorado's UrgentCare, LLC; Concentra Urgent Care; Docs on Call; Durango Urgent Care; Emergi-Care Medical Clinics; Express Care Plus; Falcon Ugrent Care - Kenneth Raper, DO; Grand Valley Urgent Care; Greeley Medical Clinic Urgent Care; Green Valley Ranch Urgent Care; Guardian Urgent Care LLC; Guardian Urgent Care LLC; Gypsum Urgent-Emergent Care; Harmony Urgent Care Center; Integrity Urgent Care - Ortho Loveland Urgent Care; Lutheran SW Urgent Care; Med Express Urgent Care; Memorial Hospital Urgent Care; Miramont Family Medicine; Mountain Peaks Urgent Care; NextCare Urgent Care;Onpoint Urgent Care; Pediatric CareNow PC; Plum Creek Urgent Care, PC; Premier Urgent Care; Rocky Mountain Urgent Care; Skyline Urgent Care; Southern Colorado Clinic; Springs Urgent and Afters Hours Care; Twenty (20) Mile Urgent Care; Urgent Care Centennial PC; Urgent Care of Colorado


Prepared by: Anthem Blue Cross Blue Shield Page 3 of 5 Connect for Health Colorado

Specialty Care Facilities:

Ambulatory Surgery Centers: Aberdeen Ambulatory Surgical center; Alpine Surgery Center LLC; Arkansas Valley Surgery Center; Black Canyon Surgical Center; Boulder Comm Musculoskeletal Surg Ct; Centrum Surgical Center; Clear Creek Surgery Center HCA; Day Surgery of Grand Junction Inc; Denver Midtown Surgery Center; Durango Surgicenter LLC; Endoscopy Center of the Rockies Boulder; Endoscopy Center of the Rockies Lafayette; Endoscopy Center of the Rockies Longmont; Endoscopy Center of Western Colorado; Foothills Surgery Center LLC; Grand Junction Endoscopy Center; Grand Valley Surgical Center LLC; Lincoln Surgery Center LLC; Lowry Surgery Center; Mid Valley Ambulatory Surgery Center LLC; Musculoskeletal Surgery Center; North Suburban Surgery Center; Orthopaedic & Spine Center of the Rockies PC; Parkwest Surgery Center; Peak One Surgery Center LLC; Physicians Surgery Center LLC; Red Rocks Surgery Center LLC; Ridgeview Endoscopy Center; Rocky Mountain Gamma Knife; Rocky Mountain Surgery Center LLC; Rose Ambulatory Surgery Center LP; Sky Ridge Surgical Center; Southwest Colorado Surgical ASC; Southwest Endoscopy Center; Surgery Center of Fort Collins; Surgery Center of Northern Colorado; Surgery Center of the Rockies LLC; Urology Surgery Center of Colorado; Vail Valley Surgery Center; Vail Valley Surgery Ctr LLC

Rehabilitative Facilities: Colorado Acute Long Term Hospital; Craig Hospital; HCA/HealthOne - Spalding Rehab;

HealthSouth Rehab Hosp of Denver; Kindred Hospitals - LTAC; Northern Colorado Long Term Acute Care Hospital; Rehab Hospital of Colorado Springs (HealthSouth); Select Specialty Hospital (Select Long Term Care Hospital - Colorado

Springs); Select Specialty Hospital Denver South - LTAC; Triumph Hospital Aurora (Kindred Hospital Aurora) - LTAC; Vibra Long Term Acute Care Hospital.

Behavioral Health Facilities: Cedar Springs Hospital Inc; Centenial Peaks Hospital; Colorado West Psychiatric Hospital; Highlands Behavioral Health Systems; Peak View Behavioral Health.

Substance Abuse Facilities: Arapahoe House; Axis Health Sytem, Bonnie Mucklow-Families at Five; Cedar Springs

Hospital; Center for Recovery; Denver Family Therapy; Highlands Behavioral; M C of Aurora; Midwestern Colorado MHC; Mind Springs Health; Mountain Crest; Parker Valley Hope; Peak view Behavioral Health; Sharon Huntoon; UHS Centennial Peaks; West Springs Hospital

Our ancillary provider network includes the following:

Lab: 55 sites including Labortory Corporation of America (Statewide) and Carent Laboratory Solutions (Northern Coloado) ;

Radiology Freestanding: Colorado Springs Imaging, Harmony Imaging Center, Parkwest Imaging Center; Pet Imaging of Northern CO; Premier Diagnostic Center; Southwest Diagnostic Ctrs of CS Ltd

DME: 231 Medical Supply sites which include: Lincare, Aerocare, Roth Medical Home Health: 86 HHA through out the state

Hospice: 36 Hospice through out the state

Skilled Nursing: 77 Skilled Nursing facilities throught out the state Dialysis: 57 Renal Dialysis Centers throught the state

Pharmacy Providers:

Our retail pharmacy network includes more than 860 pharmacies throughout Colorado and more than 68,000

pharmacies across the country. That means you have access to your prescriptions wherever you are – at home, work or even on vacation. The network includes most chains, including Albertsons, City Market, Costco, King Soopers, Rite-Aid, Safeway, Sam's Club, Target, Walgreens, and Wal-Mart, in addition to some local, independent pharmacies. To make sure your pharmacy’s in our network, visit


General Practice 8 Obstetrics & Gynecology 538


Selecting a Primary Care Physicians:

When selecting a PCP from the Pathway X network, you have several options. You may choose a physician you know, one located close to your home or office, or one that is in the same highly aligned network or medical management group as your specialist provider. We encourage you to get to know your PCP to establish a common understanding of your health care needs and goals. To change your PCP; call Customer Service at the phone number listed on the back of your health plan ID card; or on-line through the member secured access at to change your PCP.

Open Practice is 99% Family Medicine; 100% General Practice; 99% Internal Medicine; 100% Pedicatrics

Primary Care Physicians by Type and Quantity

Family Medicine 1098 Pediatrician 364

Internal Medicine 398


Accessing care from a Specialty Care Physicians: Your PCP is your first point of contact when care is needed. When you need specialist care, the PCP can recommend an appropriate specialty provider.

With this plan, you are not required to obtain a referral from your PCP to see a physician specialist. If at any time a referral is required for medically necessary treatment to at an in-network provider a standing referral will be accepted. If your referral is approved by us it cannot be retrospectively denied except for fraud or abuse. Once your referral is approved by us it cannot be changed after the preauthorization is provided unless there is evidence of fraud or abuse. However, preauthorization is required for certain services and procedures. In-network providers are responsible for obtaining preauthorization when it is required.

You are generally required to see in-network providers for non-emergency care. Under certain non-emergency circumstances, you may see an out-of-network provider, although preauthorization is required in those cases. You are responsible for confirming that preauthorization is obtained when seeing an out-of-network provider or your service will be denied and you will be responsible for the full cost.

HMO Colorado’s comprehensive specialty network includes physician specialists (surgeons, allergists, dermatologists, cardiologists, etc.); other specialists (mental and behavioral health provides, physical therapists, home health agencies, etc.); facilities (acute care hospitals, ambulatory care centers, hospices, etc.); and providers of other specialty care, including rehabilitation services.


Prepared by: Anthem Blue Cross Blue Shield Page 5 of 5 Connect for Health Colorado Specialist recommendations within a Highly Aligned Network or medical management group

When a member’s PCP is part of a highly aligned network or medical management group and you ask your PCP for a specialist recommendation, the PCP will typically refer you to a specialist within the same highly aligned network or medical management group. If preauthorization is required but not obtained for care received from an out-of-network provider, you will be financially responsible for those services.

Specialist recommendations through independent PCPs

If your PCP is not affiliated with a highly aligned network or medical management group, your PCP will make

recommendations to any specialty provider within the network. Whether you seek specialty care on your own or receive a recommendation from your PCP, it is important to stay within the network to receive coverage.

Behavioral health services

Before receiving Inpatient behavioral health and chemical dependency services, you must call for preauthorization the toll-free number which is listed on the back of your health plan ID card. A referral from your PCP is not required. A comprehensive directory that lists providers and facilities in the network is available at by calling our customer service department at the phone number listed on the back of your health plan ID card.

Allergy & Immunology 70 Optometry 403

OB/Gyns 538 Ophthalmology 218

Cardiology 388 Physical Medicine and Rehab 148

Dermatology 208 Podiatry - Surgical 101

Endocrinology 53 Pulmonary Disease 141

ENT/Otolaryngology 95 Radiation Oncology 45

Gastroenterology 213 Rheumatology 55

General Surgery 317 Urology 113

Neurology 159

Hematology/Oncology 118 Behavorial Health 1935

Infectious Disease 89

Neurosurgery 58

Orthopedics 442