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An update for members with Health Condition Amendments (riders) whose claims may have been denied
July 8, 2010

NOTE: Some current and former Wellmark members received a letter in May informing them of an error affecting some medical claims submitted under individual and Farm Bureau policies underwritten before August 2007.

 

We would like to thank our members for their patience as we reprocess claims that may have been denied because some health condition amendments, or riders, were incorrectly applied. (Read the original announcement here.)

 

The reprocessing of claims will begin in August; if you have a claim that is reprocessed, you will receive an Explanation of Health Care Benefits (EOB) that outlines Wellmark’s actions on each impacted claim, along with a letter containing more information. If it is determined your claim was denied incorrectly, you may also receive a reimbursement check as part of this mailing.

 

The error may have affected claims for pharmacy benefits.  If you believe that we have incorrectly denied such claims under an individual policy with a rider issued before August 2007, even if you did not receive an earlier letter, you may submit pharmacy receipts or other proof of the affected claim, along with your Wellmark identification number, full name and contact information, to:

           

Wellmark Claims Administration

Station 118 – VS

636 Grand Avenue

Des Moines, Iowa 50309

 

Members may also contact Wellmark’s Customer Service department by using this online form.

 

As a reminder, this error did not affect Medicare Supplement plans, Medicare Advantage plans, Short term Major Medical plans, any policies issued through a group or employer, or any policies first underwritten on or after August 1, 2007.

 

Wellmark takes pride in the value it provides to members through its products and services. We are committed to achieving 100 percent accuracy in our work and, even though this error affects a very small percentage of claims (less than one tenth of one percent over a 10-year period), we are working to resolve this matter promptly.

 

Again, we appreciate our members’ patience during this process.

 

Contact Wellmark Media Relations

Traci McBee
Phone: 515-376-4338
mcbeet@wellmark.com

 

Teresa Roof
Phone: 515-376-5869
rooft@wellmark.com

 

1331 Grand Avenue
Des Moines, IA 50309-2901

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