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3 ways to avoid health insurance surprises

Simple steps before receiving care

This article was last updated June 26, 2023.

How to get the most from your benefits and avoid surprises

You’ve just found out you need treatment. Whether it’s an extra appointment, hospital stay, test or outpatient treatment program, the last thing you want to worry about is whether or not your insurance will cover it.

Here are three things you can do that will help you better understand your benefits and avoid any surprises.

  1. See an in-network doctor you trust.
    When it comes to navigating the health care system, your primary care physician (PCP) is your primary ally.
    “Primary care physicians have such a broad range of knowledge,” says Dr. Tim Gutshall, chief medical officer at Wellmark Blue Cross and Blue Shield. “They are someone you can count on for giving good advice on where to go if you need specific treatment.”
    Whether you have an HMO plan or PPO plan, it’s important to have a personal doctor who is in your plan’s network to ensure you have access to high-quality care and keep your health care costs affordable. Looking for a primary care physician? Log in to myWellmark® to search for an in-network provider.
  2. Know your treatment plan.
    After you’ve found an in-network doctor or care facility, it’s important to ask these questions before you receive care:
    • Does my insurance cover the services you think I need?
    • When you recognize that services may not be covered, will you talk to me first?
    • How will you work with my insurance company during my treatment to limit my financial burden?
    • What happens if you deliver care that is not covered by my insurance plan?
    • Am I required to sign a release to pay for services not covered by my insurance, and will you treat me if I don’t?
    “It’s important for our members to really understand the coverage and services they’ll receive up-front,” says Dr. Gutshall. “Make sure you have a family member or friend who can go along with you to appointments. Having an extra set of eyes and ears can help you understand the information that’s being shared.”
  3. Make sure it’s covered.
    When it comes to understanding how your benefits work, you don’t have to do it alone. Wellmark is here to help.
    Before starting any new treatment plan or program, log in to myWellmark to find out if it’s covered Secure Site under your health plan. You can also call BeWell 24/7SM at Eight, Four, Four, Eight, Four, Be Well any time to get an explanation of your treatment and to be connected to someone who can explain how your benefits work. Plus, Wellmark Customer Service is just a phone call away. 
    If you believe something should have been covered, it’s important to contact us. Wellmark has the opportunity to engage an independent third party to review additional information to see if the services are necessary.
    “The most important thing for Wellmark is that our members get the right care,” says Dr. Gutshall. “We are here to help you.”