“I don’t want to be surprised by unexpected bills.”
Five questions to ask before receiving care.
BEING AN INFORMED
HEALTH CARE CONSUMER
CAN SAVE YOU MONEY.
There’s nothing more
frustrating than receiving
your Explanation of Benefits
(EOB) and finding out you have
unplanned out-of-pocket costs.
To get the greatest value from
your health benefits, get the
answers to these five questions
before care is provided.
Go to Wellmark.com/
Member to learn
more about using
your benefits.
Know the answers to these five questions.
1 DO I HAVE BENEFITS FOR THIS PROCEDURE OR SERVICE?
Health plans don’t cover everything. And what your plan may cover may be different
than what your neighbor’s plan covers. Always check to see if you have benefits
before receiving care by logging into myWellmark.com. Your personalized Web portal,
myWellmark, is where you can find information to manage your health, your health plan
and your health care costs all in one place.
2 ARE MY HEALTH CARE PROVIDERS AND OTHER PROVIDERS IN
MY NETWORK?
It’s important to make sure care is being provided by network or contracting providers.
If you are having a procedure, verify the facility, anesthesiologist, labs, and doctor
performing the procedure are contracting providers.
If you’re not sure that your provider is in the network, visit Find a Doctor or Hospital on
Wellmark.com. By choosing an in-network provider, you’ll receive the highest level of
benefits with the lowest out-of-pocket costs.
3 DOES THIS PROCEDURE OR SERVICE NEED TO BE APPROVED AHEAD
OF TIME?
There are some procedures or services that require prior approval. Prior approval helps
determine if a proposed treatment plan is medically necessary and follows nationally
approved medical guidelines. Wellmark contracting providers in Iowa and South Dakota
request prior approval for you. A list of services requiring prior approval is on
Wellmark.com > Members > Using Your Benefits > Pre-Service Review Requirements.
If you receive care from an Iowa or South Dakota provider who contracts with Wellmark
and the prior approval step does not occur before the service or procedure occurs, the
provider will not be paid.
You, or someone acting on your behalf, is responsible for prior approval if you receive
care from a provider in Iowa or South Dakota who does not contract with Wellmark or
any provider outside of Iowa or South Dakota. For example, if you receive care from
a provider who does not contract with Wellmark, even if located in Iowa and South
Dakota, and the prior approval step does not occur before receiving the service or
procedure, the claim will deny on the belief that you did not request prior approval and
you will be responsible for the costs. You may appeal the decision if this occurs.
Your life’s busy.
LET US HELP YOU WITH THE
HEALTH PART.
myWellmark is your personalized site to
manage your health and make the most of
your coverage. Use myWellmark to:
ii Better understand your health benefits.
Know the answers to these five
questions (continued)
ii Find a contracting health provider.
ii Keep all your family’s medical records
and information in one place.
Always ask your provider if he or she has fulfilled all prior approval
requirements before care is given. If the provider has not submitted the
prior approval, call the precertification phone number on your ID card
before receiving services.
ii Track and organize your medical claims
and expenses.
ii Sign up to receive your health
statements online.
4 DOES WELLMARK NEED TO BE NOTIFIED BEFORE BEING
ii Get health news, resources and tips.
Wellmark does need to be notified about some types of admissions.
You can find out when a notification must occur by looking at the
authorization table on Wellmark.com > Members > Using Your Benefits >
Pre-Service Review Requirements. The authorization table is also the
resource your provider uses to determine all notification requirements.
REGISTER TODAY AT WELLMARK.COM
If you receive care from an Iowa or South Dakota provider who contracts
with Wellmark, the provider is responsible for the notification. If you
receive care from a facility who does not contract with Wellmark (for
example, a facility not located in Iowa or South Dakota), you or someone
acting on your behalf, is responsible for notifying Wellmark by calling the
precertification phone number on your Wellmark ID card.
ADMITTED TO THE HOSPITAL?
5 DOES THE DRUG I’M BEING PRESCRIBED REQUIRE
PRIOR AUTHORIZATION?
For some drugs, your doctor will need to get approval from Wellmark
before the pharmacist can fill the prescription and have it covered under
your benefits. Your doctor will need to take care of this step for you. A
list of drugs requiring prior authorization is available on Wellmark.com >
Health and Wellness > Drug Information > Special Pharmacy Programs.
You can also search the Wellmark Drug List to find out if a drug has any
special requirements.
Independent Licensees of the Blue Cross and Blue Shield Association. Blue Cross®, Blue Shield® and the Cross® and Shield® symbols are registered marks of the
Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans. Wellmark® is a registered mark of Wellmark, Inc. © 2012 Wellmark,Inc.
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