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An update for members with Health Condition Amendments (riders) whose claims may have been denied
December 13, 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 reprocessed claims that may have been denied because some health condition amendments, or riders, were incorrectly applied.

 

The reprocessing of claims is nearly complete. If you had a claim that was reprocessed, you would have received an Explanation of Health Care Benefits (EOB) that outlines Wellmark’s actions on each impacted claim. If it was determined your claim was denied incorrectly and additional benefits were owed, you or your provider may have also received a reimbursement check.

 

If you received a reimbursement check, you will also receive a separate check for interest based on the reimbursement amount. We expect interest checks to be mailed before the end of the year.

 

Please contact us before the end of the year if you feel you may have additional medical or pharmacy claims that were incorrectly denied due to the application of health condition amendments under an individual policy with a rider issued before August 2007.

 

Members may 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.

 

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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