Orthopedic Surgeons That Accept Anthem
1 verified providers accept Anthem
About Anthem
Anthem is a BCBS licensee covering more than 45 million members across 14 states (CA, CO, CT, GA, IN, KY, ME, MO, NV, NH, NY, OH, VA, WI). The parent company rebranded to Elevance Health in 2022, but member cards still say Anthem and the insurance is referred to that way universally.
Orthopedic Coverage Overview
Anthem covers the standard orthopedic spectrum: visits, imaging, PT, injections, and surgery. As a BCBS affiliate, members get BlueCard network access when traveling out of state. Prior authorization rules vary by plan but are most strict for elective procedures like total joint replacement, spinal fusion, and complex shoulder surgery. Anthem PPO is widely accepted by orthopedic groups. HMO acceptance is narrower.
Anthem Plan Types
Anthemsells multiple plan products and they don't all share the same orthopedic network. Confirm the specific plan name with the office when scheduling.
Anthem PPO
Anthem's standard PPO product (also branded as Blue Access PPO in some markets). Broad orthopedic surgeon network in the 14 Anthem states. No referrals.
Anthem HMO
Lower premium with required PCP referrals to orthopedic specialists. Networks are state-specific within the 14 Anthem markets.
Anthem BlueCross HealthKeepers
Anthem's Virginia HMO product. Tighter network than commercial Anthem PPO but well-established for orthopedic care.
Anthem Medicare Advantage
Branded as Anthem Senior Advantage or MediBlue depending on state. Network is separate from commercial Anthem and often narrower.
Anthem Medicaid (HealthLink, etc.)
State Medicaid managed-care product, branded by state. Lower reimbursement and lower network density than commercial Anthem.
Common Orthopedic Procedures and Anthem Coverage
How Anthem typically handles the most common orthopedic surgeries. Coverage rules can vary by specific plan — verify with your benefits documents.
Out-of-pocket ranges below are estimates aggregated from CMS facility-charge data, plan-tier comparisons, and reported member experiences. Actual costs depend on your specific employer plan, deductible, network status, and the surgeon's contract with Anthem. Always confirm with Anthemmember services and the surgeon's billing office before scheduling.
| Procedure | Anthem Coverage Notes |
|---|---|
| Total Knee Replacement | Covered with prior auth. Anthem applies clinical criteria including failed conservative care; approvals typically take 5-10 days. As a BCBS affiliate, BlueCard travel benefits apply if you have surgery out of state. |
| Total Hip Replacement | Covered. Same prior auth process as knee. Anthem covers outpatient hip replacement when clinical criteria support it. |
| ACL Reconstruction | Covered. Prior auth typically required for the surgical procedure but rarely denied for fully torn ACLs with confirmatory MRI. |
| Rotator Cuff Repair | Covered. Conservative care documentation may be required for partial-thickness tears. Full-thickness tears with MRI confirmation typically approve. |
| Spinal Fusion | Covered with strict clinical review. Anthem uses AIM Specialty Health for prior auth on spinal procedures and requires documented failure of 6-12 weeks of conservative care for elective lumbar fusion. |
| MRI (Knee/Spine/Shoulder) | Anthem routes most MRI prior auth through AIM Specialty Health. Standard clinical criteria apply — usually a trial of PT or other conservative care unless red-flag symptoms are present. |
Prior Authorization
Anthem uses AIM Specialty Health for radiology and surgical benefit management on most commercial plans. Approvals typically take 5-10 business days for elective surgery, 2-4 days for advanced imaging. Members and providers can track status at anthem.com or via the Sydney Health app.
Network Strength
Anthem's commercial orthopedic network is strong throughout its 14 home states, particularly in California, Connecticut, Indiana, Kentucky, New York (upstate), Ohio, and Virginia. Where Anthem is the dominant carrier (Indiana, Kentucky, Connecticut, parts of Ohio), most local orthopedic groups participate. Network density is more variable on Medicare Advantage and Medicaid plans.
Things to Watch With Anthem
- Anthem branding varies by state — your card may say "Anthem Blue Cross" (CA, CO, NV) or "Anthem Blue Cross Blue Shield" (other states). The networks are still managed by Anthem but state-specific.
- AIM Specialty Health denials of MRI orders follow standard clinical criteria — usually 4-6 weeks of conservative care unless red flags are present.
- Anthem Medicaid and commercial Anthem are separate networks — confirm the specific product the orthopedic office accepts.
- BlueCard works for Anthem members traveling to non-Anthem states, but routine care is best handled in your home Anthem state.
Providers Accepting Anthem
Showing 1-1 of 1 providers
Anthem by Specialty
Frequently Asked Questions About Anthem and Orthopedic Care
How do I find an orthopedic surgeon that accepts Anthem?
Use the AdvOrtho search to browse orthopedic surgeons and filter by insurance plan. Providers who have verified their Anthem acceptance appear in results. Always confirm with the office directly when scheduling — networks change and the specific Anthem product matters (PPO vs HMO vs Medicare Advantage may have different acceptance).
Does Anthem cover orthopedic surgery?
Anthem generally covers medically necessary orthopedic procedures including joint replacement, ACL reconstruction, rotator cuff repair, and spinal surgery. Coverage details, deductibles, and prior authorization requirements vary by plan type. Review the section above for plan-specific details, or contact Anthem directly for your exact benefits.
Do I need a referral to see an orthopedic surgeon with Anthem?
It depends on your Anthem plan type. HMO plans typically require a referral from your primary care physician. PPO and POS plans usually allow direct access to orthopedic specialists without a referral, though some HMO products allow self-referral within their network.
How many orthopedic surgeons accept Anthem?
AdvOrtho lists 1 orthopedic providers who have indicated they accept Anthem. Provider networks change regularly — confirm acceptance directly with the office before scheduling, especially for elective procedures.
Is Anthem the same as Blue Cross Blue Shield?
Anthem is a BCBS licensee — meaning it operates BCBS plans in 14 states under license from the BCBS Association. So yes, Anthem plans are BCBS plans, but only in those 14 states. Outside Anthem's territory, the BCBS plan is run by a different licensee (Highmark in PA, Florida Blue in FL, etc.).
Why did Anthem rebrand to Elevance Health?
Elevance Health is the name of the parent corporation since 2022. The consumer-facing insurance brand is still Anthem (and BCBS in some states). Member cards, provider directories, and patient communications all still say Anthem. The rebrand affects investor and corporate messaging but not how members interact with the plan.
How does Anthem prior authorization work for orthopedic surgery?
Anthem uses AIM Specialty Health for surgical and radiology benefit management. The orthopedic office submits a clinical request including imaging and conservative care notes. Approvals typically take 5-10 business days for elective surgery. If denied, your surgeon can request a peer-to-peer review with an AIM physician.
Can I use my Anthem plan in another state?
Yes, through the BlueCard program. Anthem members get in-network rates with BCBS providers in any other state when traveling. Routine and non-urgent care is best received in your home Anthem state to avoid coordination issues; urgent care and emergencies are fully covered nationwide.
Does Anthem cover physical therapy after orthopedic surgery?
Yes. Most Anthem plans cover outpatient PT with a session limit per calendar year (typically 20-60 visits, plan-dependent). After certain visit counts, ongoing PT may require additional authorization. Inpatient rehab after major joint replacement is covered separately and requires its own auth.
Insurance coverage information is provided for general guidance only. Always verify coverage details, copays, and prior authorization requirements directly with Anthemor your provider's office before scheduling treatment.
Are you a provider that accepts Anthem?
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