Effective January 1, 2018, the Welfare Fund has eliminated the referral process for specialist office visits. Beginning the first of the year if you need to see a specialist, you no longer need to get a referral from your Primary Care Physician (PCP). You can just call the specialist directly to make an appointment. Please keep in mind that you must still use a participating Anthem BC/BS provider. To locate an Anthem participating provider, you should call 1.800.810.BLUE (2583) or visit Anthem’s website at www.anthem.com.
Effective January 1, 2018, services that require Pre-certification will be handled by American Health Holding (AHH), the Welfare Fund’s new Pre-Certification Company. AHH will be replacing Quantum, so beginning the first of the year you will no longer call Quantum to obtain any necessary Pre-certification. You or your provider can reach AHH by calling the Fund office at 860.728.1100 or 1.800.227.4744 and listen for the prompt that will connect you with AHH.
The following is a PARTIAL list of services that require Pre-Certification:
- CT Scans
- All In-Patient Admissions
- Many Outpatient Surgeries
Please call AHH for a complete list of services and procedures that require Pre-Certification. Participants are ultimately responsible for obtaining any required Pre-Certification. Penalties will be applied to claims that were not Pre-Certified as required. You will be receiving new ID cards in December 2017 with the updated telephone number for obtaining Pre-Certification. Please be sure to show your provider your new ID card for any services provided after January 1, 2018.
Effective January 1, 2018, please call the Welfare fund for Eligibility, Benefit and Claim status inquires. Beginning the first of the year, Quantum will no longer be handling these services for the Welfare Fund. When calling the Welfare Fund you will hear an automated operator guiding you to each of the Fund’s Departments.
The plan amendment is effective on 1/1/2018 and can be viewed at: