Learn More About Your Prescription Drug Coverage

The COVA Care health plan now includes a three-tier prescription drug program. If you have questions about the three-tier drug structure, or want to find in what tier your drug falls, visit the new Three-Tier Drug Fact Sheet . There's also Additional Information that addresses other resources relating to prescription drugs.

More about prescription drugs may be found on the Commonwealth of Virginia and The Local Choice site on the Anthem Web site at www.anthem.com , or visit the Medco Web site at www.medcohealth.com .

Ask the Ombudsman

Question: I will soon be undergoing an expensive medical procedure. Is there any way to know my costs beforehand so that I can anticipate expenses?

Answer: Yes. You can find out upfront what your out-of-pocket expenses may be for a specific inpatient or outpatient procedure. This is especially important if you have the Out-of-Network coverage option with COVA Care, since your doctor may not accept Anthem's allowable charge for services and may bill you for the balance of charges that are over the allowable charge amount.

Anthem Member Services can usually give you your out-of-pocket expenses provided you give them some information, which you should obtain from your provider. Call Anthem Member Services to give the diagnosis, procedure code, charge, name of the provider and the place of treatment (i.e., physician's office, outpatient hospital, etc.). If any of that information is different when the claim is submitted, your expenses may be different.

Some services require Medical Necessity Review to determine coverage. Ask your provider to contact the Anthem Medical Management area toll free at 1-800-242-7277 or in Richmond at 804-359-7277 to request this review. The provider needs to give the specific procedure and clinical rationale for the procedure.

Anthem Blue Cross and Blue Shield Member Services: (804) 355-8506 in Richmond or 1-800-552-2682 outside Richmond (COVA Care Plan)

Issues or concerns about your health benefits? Contact the Ombudsman at eesvcs@dhrm.state.va.us