What Is an ASC?
Ambulatory surgery centers—known as ASCs—are modern healthcare facilities focused on providing same-day surgical care, including diagnostic and preventive procedures.
For outpatient procedures, hospitals typically charge much more than Ambulatory Surgery Centers (ASCs), and multiple studies indicate that higher cost does not always mean higher quality. There is no documented evidence that hospitals have better outcomes, while ASCs have established track records of providing quality outcomes that are at least as good as or better than hospitals. Below are examples of the variance in cost.
Ambulatory surgery centers—known as ASCs—are modern healthcare facilities focused on providing same-day surgical care, including diagnostic and preventive procedures.
For outpatient procedures, hospitals typically charge much more than Ambulatory Surgery Centers (ASCs), and multiple studies indicate that higher cost does not always mean higher quality. There is no documented evidence that hospitals have better outcomes, while ASCs have established track records of providing quality outcomes that are at least as good as or better than hospitals. Below are examples of the variance in cost.
Effective October 1, 2018, SISC PPO plans will limit the maximum benefit amount at an in-network outpatient hospital facility for the following five procedures:
The Ambulatory Surgery Center Process
Certain procedures require Ambulatory Surgery Centers (unless the facility is 30 miles from the District’s zip code) such as
Arthroscopy, Cataract Surgery, Colonoscopy, and Upper GI Endoscopy (with or without Biopsy).
If you use an in-network ASC for one of these procedures, then you will only be responsible for the deductibles and copayments based on the plan you are enrolled in. Ukiah does not have an Ambulatory Surgery Center. To use this option, please call Anthem or use the “find a provider” on the Anthem website to locate the nearest Ambulatory Surgery Center facility.
If you use an Anthem out-patient hospital facility for one of these procedures, you will be responsible for the regular deductible and coinsurance based on the plan you are enrolled in PLUS any amount by which the hospital charges exceed the maximum benefit. Check with Anthem/SISC for a complete list of procedures that require the use of ASCs.
If you need one of the outpatient procedures on the list, it will be up to you to either request treatment at an in-network ASC or have your doctor obtain an advance certification from Anthem. If the ASC is further than 30 miles from the District’s zip code (95482), you can have your physician complete and sign the Hospital Outpatient Facility Request Form to get benefits paid according to the plan you are enrolled in. This form is required for patient safety reasons due to the distance from an In-Network Ambulatory Surgery Center (ASC).
Ukiah Unified members or their physician’s office can fax the form to Anthem Customer Service at 866-763-1576. If the patient or provider prefers to email the attached form, they may do so by calling Anthem Customer Service at 800-825-5541 to request a representative’s email address. Please make sure to complete this process prior to receiving services and obtain approval.
You can also call Anthem and get the claim adjudicated, if your physician did not submit or prior approval.
Please call Anthem Customer Service at (800) 825-5541 and inform them:
“I would like to file an appeal to send this claim to adjustment. I live in Ukiah and there is no Ambulatory Surgery Center available within 30 miles.”
In addition, always call Anthem to get the most up to date information: (800) 825-5541.
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