Health insurance administrative fees
While the term “administrative fees” may seem vague, Wellmark Blue Cross and Blue Shield's administrative fees are transparent, meaning you can be sure of where your dollars are going and how they benefit your employees and your business. Let's get into it.
How administrative fees work with health insurance
Wellmark's administrative fees are all-inclusive so you get more value at no additional cost. By working with Wellmark, your employees get access to valuable programs and solutions, and you get help managing the total cost of care. For Wellmark, admin fees go toward the cost of things like:
- Health services
- A comprehensive pharmacy program
- Customer service
- Personalized account management
- Health plan network management
- And more
We'll take a closer look at some of these services.
Health services
With Wellmark, your admin fees are re-invested into programs that help improve your employees' health care experience, such as BeWell 24/7® — a hotline available anytime day or night that connects employees with medical providers who can answer their health care questions.
Another program, Wellmark’s Case Management Program, offers personalized guidance to employees with complex or chronic physical and mental health conditions. To increase support for your employees’ mental health, admin fees have contributed to the addition of a Wellmark behavioral health medical director and behavioral health case managers and social workers dedicated to supporting employees with anxiety or depression.
Pharmacy program
Wellmark’s pharmacy program is based on lowest net spend transparency. We invest in enhancements to our clinical programs like prior authorization, opioid management, specialty pharmacy and drug utilization reviews that result in the lowest overall drug costs for you.
Payment protection
The administrative fees you pay with your health insurance costs go a long way in ensuring claims and payments are processed in an accurate and timely manner. We are doing more to improve payment accuracy, which is why payment integrity is part of every step of the claims process.
Customer service
Wellmark’s best-in-class service comes from a local staff that focuses on the member — your employee — not the transaction. Our customer service staff are called customer experience advocates (CXAs) because they are empowered to advocate for your employees. They take responsibility for helping employees navigate the health care system, understand their benefits and get their health insurance questions answered.
Get the most from Wellmark
You go the extra mile to make sure your employees have the best health insurance, so make sure you’re getting the most from Wellmark. With Employer Connection, you can manage your account, pay your bill and download free educational materials to keep your employees engaged in their health care.
Haven't heard of Employer Connection? Learn how it can benefit your business.
Personalized account management
When you work with our trusted advisors, you will develop an account strategy and multi-year plan that meets your strategic goals. You're not alone in the process. Our team provides consultative support, strategic direction and serves as your primary contact on products and resources to support your business.
With Wellmark, you have access to a variety of tools to provide your employees with the best care possible and keep your costs down. Group-specific data means you will receive personalized, data-driven recommendations on services that may benefit your employees like mental health services, pregnancy support and specialty drug utilization management.
Network management
Local and national network management ensures quality care for your employees and eliminates the additional costs that come with out-of-network contracts. From traditional to more progressive, we design network solutions that offer members access to the right providers, like Blue Distinction® Centers for when they need specialty care or Blue Cross Blue Shield Global® Core for health care while traveling.
Maximizing value for you and your employees
When you pay admin fees, the value comes back to you and your employees through new programs, solution and enhancements, such as:
- Increased capabilities for radiology and cardiovascular imaging review for prior authorizations. This program uses evidence-based criteria to identify the most clinically appropriate imaging procedures and ensure the correct use of specialized services to reduce the costs you pay in claims.
- A year-long review of industry-leading pharmacy benefits managers. Through this effort, Wellmark negotiated deeper discounts for you and best-in-class tools and support for your employees.
- Enhancements to myWellmark® to increase employee engagement. Employees can log in to myWellmark to find enhancements, such as a provider finder, a free anxiety and depression screening to help employees identify the signs of a mental health condition and behavioral health resources. Encourage your employees to register for myWellmark so they can easily find in-network care, get a cost estimate before they receive care and get more engaged in their health care.
Have more questions about admin fees? Contact your local Wellmark account representative or email us at blueatwork@wellmark.com.
Disclosures
BeWell 24/7® is a registered mark of Wellmark, Inc.
Blue Cross Blue Shield Global® is a registered mark of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.
Blue Distinction Centers (BDC) met overall quality measures for patient safety and outcomes, developed with input from the medical community. A Local Blue Plan may require additional criteria for providers located in its own service area; for details, contact your Local Blue Plan. Blue Distinction Centers+ (BDC+) also met cost measures that address consumers’ need for affordable healthcare. Each provider’s cost of care is evaluated using data from its Local Blue Plan. Providers in CA, ID, NY, PA, and WA may lie in two Local Blue Plans’ areas, resulting in two evaluations for cost of care; and their own Local Blue Plans decide whether one or both cost of care evaluation(s) must meet BDC+ national criteria. National criteria for BDC and BDC+ are displayed on www.bcbs.com. Individual outcomes may vary. For details on a provider’s in-network status or your own policy’s coverage, contact your Local Blue Plan and ask your provider before making an appointment. Neither Blue Cross and Blue Shield Association nor any Blue Plans are responsible for non-covered charges or other losses or damages resulting from Blue Distinction or other provider finder information or care received from Blue Distinction or other providers.